摘要:
目的：研究多原发肺癌（MPLC）的临床、病理及CT表现，分析其预后及生存相关因素，为其临床诊治及预后评估提供理论依据。方法：回顾2009年1月1日至2014年12月31日在我院确诊并至少具有3年随访数据的MPLC患者共93例，分析其临床、病理及CT资料，并进行生存分析检验。结果：93例患者中，同时性多原发肺癌86例（92.5%），异时性多原发肺癌7例（7.5%）；男性47例（50.5%），女性46例（49.5%）；发病年龄39~79岁，中位年龄58岁；有吸烟史33例（35.5%）；肺气肿22例（23.7%）；Ⅰ期患者62例（66.7%），Ⅱ期12例（12.9%），Ⅲ期15例（16.1%），Ⅳ期4例（4.3%）。93例患者中共有205个原发肿瘤病灶，以腺癌为主（94.2%），最大径0.4~8.3cm，中位数1.9cm。CT多表现为双原发肺癌（81.7%），48例（51.6%）为肺部实性结节/肿块伴GGN，30例（32.3%）为多发GGN；病灶有分叶148例（72.2%）、毛刺118例（57.6%），血管集束征115例（56.1%）、胸膜凹陷征125例（61.0%）。术后3年总体生存率为94.6%，无病生存率为84.9%。吸烟史（P=0.016）、肿瘤最大径（P=0.036）、胸膜凹陷征（P=0.045）、支气管截断征（P=0.024）为影响MPLC患者无病生存期的独立危险因素。结论：MPLC以腺癌最常见，最大肿瘤病灶多具有原发性肺癌的典型CT表现；肺部实性结节/肿块伴单发或多发GGN、肺部多发GGN应首先考虑到MPLC的可能。MPLC的预后较好，吸烟史、肿瘤大小、胸膜凹陷征、支气管截断征为影响患者预后的独立相关因素，早期诊断及手术治疗可使MPLC患者获得较好的预后。
Abstract:
Objective: To study the clinical, pathological and CT features of patients with multiple primary lung cancer (MPLC), analyze its prognosis and survival related factors, and provide theoretical basis for its clinical diagnosis, treatment and prognosis evaluation. Methods: A total of 93 MPLC patients diagnosed in our hospital from 2009-01-01 to 2014-12-31 with at least 3 years of follow-up data were reviewed. The clinical, pathological and CT data of the patients were analyzed, and survival analysis was performed. Results: Among the 93 patients, 86(92.5%) had synchronous multiple primary lung cancer and 7(7.5%) had metachronous multiple primary lung cancer. There were 47 males (50.5%) and 46 females (49.5%) with ages from 39 to 79 years ($\tilde x$=58 years). Of the 93 patients, 33 cases (35.5%) had a history of smoking; 22 cases of emphysema (23.7%) 62 cases (66.7%) were in stageⅠ, 12 cases (12.9%) in stageⅡ, 15 cases (16.1%) in stage Ⅲ, 4 cases (4.3%) in stage Ⅳ. A total of 205 primary tumor lesions were found in 93 patients, mainly adenocarcinoma (94.2%), with diameters of 0.4~8.3cm ($\tilde x$=1.9cm). CT mainly manifested as double primary lung cancer (81.7%), 48 cases (51.6%) showed solid nodules/masses with GGN, and 30 cases (32.3%) were multiple GGN. Lobulation were found in 72.2% cases, speculation sign in 57.6% cases, vascular bundle sign in 56.1% cases, and pleural indentation in 61.0% cases. The 3-year overall survival rate after surgery was 94.6% and the disease free survival rate was 84.9%. Smoking history (P=0.016), maximum tumor diameter (P=0.036), pleural indentation (P=0.045) and bronchial truncation sign (P=0.024) were independent risk factors for disease-free survival of MPLC patients. Conclusion: Adenocarcinoma was the main pathological type among MPLC. The largest lesion had the malignant characteristics of primary lung cancer, particularly the presence of single or multiple GGN. The overall prognosis of MPLC is good. Smoking history, tumor size, pleural indentation and bronchial truncation sign are independent risk factors influencing the prognosis of patients. Early diagnosis and surgical treatment may achieve better prognosis.
百度学术
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