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中华胸部外科电子杂志 ›› 2015, Vol. 02 ›› Issue (03) : 161 -167. doi: 10.3877/cma.j.issn.2095-8773.2015.03.005

所属专题: 文献

论著

肺腺鳞癌外科疗效分析
杨海堂1, 姚烽1, 孙益峰1, 余科科2, 顾海勇1, 陈天翔1, 赵珩1,()   
  1. 1. 200030 上海交通大学附属胸科医院胸外科
    2. 200030 上海交通大学附属胸科医院病理科
  • 收稿日期:2015-06-12 出版日期:2015-08-28
  • 通信作者: 赵珩

Clinical outcomes of primary adenosquamous carcinoma of the lung treated by surgery

Haitang Yang1, Feng Yao1, Yifeng Sun1, Keke Yu2, Haiyong Gu1, Tianxiang Chen1, Heng Zhao1,()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
    2. Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2015-06-12 Published:2015-08-28
  • Corresponding author: Heng Zhao
  • About author:
    Corresponding author: Zhao Heng, Email:
引用本文:

杨海堂, 姚烽, 孙益峰, 余科科, 顾海勇, 陈天翔, 赵珩. 肺腺鳞癌外科疗效分析[J/OL]. 中华胸部外科电子杂志, 2015, 02(03): 161-167.

Haitang Yang, Feng Yao, Yifeng Sun, Keke Yu, Haiyong Gu, Tianxiang Chen, Heng Zhao. Clinical outcomes of primary adenosquamous carcinoma of the lung treated by surgery[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(03): 161-167.

目的

探讨分析原发性肺腺鳞癌(ASC)临床病理特征及预后因素。

方法

回顾性分析上海市胸科医院胸外科2008年10月至2014年12月术后病理证实为原发性肺ASC患者的临床资料。分别分析ASC患者3年和5年的总生存率以及5年无病生存率,采用单因素和多因素分析影响总生存期和无病生存期的预后因素。

结果

该研究共有205例ASC患者纳入分析,其中男性145例(70.7%),女性60例(29.3%);年龄21~70岁,平均年龄(60.7 ± 9.7)岁。N0、N1和N2期(N0 vs N1,P=0.031;N1 vs N2,P=0.037)之间以及Ⅰ、Ⅱ和ⅢA期(Ⅰ vs Ⅱ,P=0.021;Ⅱ vs ⅢA,P=0.007)患者之间预后均有统计学差异。Cox多因素回归分析表明:肿瘤T分期(P=0.011)、TNM分期(P<0.001)以及辅助化疗(P=0.008)是总生存期的独立预后因素;而TNM分期(P<0.001)和辅助化疗(P=0.005)是预测相应无病生存期的独立因素。

结论

ASC患者的预后与肿瘤的T分期和TNM分期有关;术后辅助化疗能提高ASC患者的生存。

Objective

To analyze the clinicopathological characteristics and prognostic factors associated with primary adenosquamous carcinoma (ASC) of the lung.

Methods

The clinical data of patients with ASC of the lung confirmed by postoperative pathology between October 2008 and December 2014 in Shanghai Chest Hospital were retrospectively analyzed. The 3-year overall survival, 5-year overall survival and 5-year disease-free survival of patients was analyzed, and the prognostic factors for overall survival and disease-free survival were explored by univariate analysis and multivariate analysis.

Results

A total of 205 patients were identified, including 145 (70.7%) males and 60(9.3%) females with an average age of (60.7±9.7) years (range 21-70 years). There were significant differences in the prognosis among patients with N0, N1 and N2(N0 vs N1, P=0.031; N1 vs N2, P=0.037) and among patients with Ⅰ, Ⅱ and ⅢA(Ⅰ vs Ⅱ, P=0.021; Ⅱ vs ⅢA, P=0.007). Cox multivariate analysis demonstrated that T stage of tumor(P=0.011), TNM stage (P<0.001) and adjuvant chemotherapy(P=0.008) were independent prognostic factors for overall survival, and TNM stage (P<0.001) and adjuvant chemotherapy(P=0.005) were independent prognostic factors for disease-free survival.

Conclusions

The prognosis of ASC is associated with T stage and TNM stage, and postoperative adjuvant chemotherapy can increase the survival of patients with ASC.

表1 原发性肺ASC的临床特征
表2 ASC患者的术前病理诊断与术后病理分期
图1 按照术后病理T分期的总生存率比较
图2 按照术后病理N分期的总生存率比较
图3 按照术后病理TNM分期的总生存率比较
表3 单因素分析影响DFS和OS的预后因素
因素 例数(%) DFS OS
平均数(±s,月) t P 平均数(±s,月) t P
性别 ? ? 0.014 0.905 ? 0.046 0.831
? 男性 145 (70.7) 40.6±2.6 ? ? 50.7±2.4 ? ?
? 女性 60 (29.3) 37.3±3.6 ? ? 47.4±3.9 ? ?
年龄(岁) ? ? 0.016 0.898 ? 0.204 0.652
? ≤60 94 (45.9) 40.5±3.0 ? ? 49.4±2.9 ? ?
? >60 111 (54.1) 37.8±3.0 ? ? 49.4±2.8 ? ?
吸烟史 ? ? 1.400 0.237 ? 1.052 0.305
? 80 (39.0) 42.4±2.8 ? ? 51.7±2.6 ? ?
? 125 (61.0) 34.3±3.1 ? ? 45.7±3.1 ? ?
位置 ? ? 0.145 0.703 ? 0.035 0.852
? 中央型 45 (22.0) 35.4±4.1 ? ? 45.4±3.5 ? ?
? 周围型 160 (78.0) 40.8±2.5 ? ? 50.6±2.3 ? ?
脏层胸膜浸润 ? ? 12.39 0.211 ? 1.767 0.184
? 96 (46.8) 43.4±3.4 ? ? 52.8±3.1 ? ?
? 109 (53.2) 35.1±2.5 ? ? 46.6±2.5 ? ?
肿瘤大小(cm) ? ? 0.959 0.327 ? 2.318 0.128
? ≤3 73 (35.6) 41.0±3.4 ? ? 52.9±3.2 ? ?
? >3 132 (64.4) 38.6±2.7 ? ? 47.9±2.6 ? ?
因素 例数(%) DFS OS
平均数(±s,月) t P 平均数(±s,月) t P
T分期 ? ? 15.88 <0.001 ? 26.90 <0.001a
? T1期 40 (19.5) 43.3±4.7 ? ? 56.0±4.4 ? ?
? T2期 136 (66.3) 42.7±2.8 ? ? 52.5±2.5 ? ?
? T3期 29 (14.1) 21.0±3.1 ? ? 29.0±3.5 ? ?
N分期 ? ? 46.61 <0.001 ? 29.30 <0.001
? N0期 99 (48.3) 53.8±3.1 ? ? 60.4±2.6 ? ?
? N1期 37 (18.0) 34.7±4.5 ? ? 45.8±4.3 ? ?
? N2期 69 (33.7) 22.1±2.7 ? ? 35.1±3.2 ? ?
TNM分期 ? ? 49.68 <0.001 ? 34.79 <0.001
? Ⅰ期 82 (40.0) 56.3±3.4 ? ? 63.0±2.8 ? ?
? Ⅱ期 43 (21.0) 38.8±3.9 ? ? 47.9±3.6 ? ?
? ⅢA期 80 (39.0) 22.8±2.6 ? ? 35.2±3.0 ? ?
辅助治疗 ? ? 4.363 0.037 ? 4.883 0.027
? 143 (69.8) 43.2±2.7 ? ? 53.2±2.4 ? ?
? 62 (30.2) 31.8±3.4 ? ? 42.2±3.5 ? ?
表4 多因素分析影响DFS及OS的预后因素
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