本文選題：肺神經(jīng)內(nèi)分泌腫瘤 + 類癌��； 參考：《青海大學(xué)》2017年碩士論文

【摘要】：目的:探討肺神經(jīng)內(nèi)分泌腫瘤的臨床病理特征,并分析臨床病理特征與預(yù)后關(guān)系。方法:收集2014年12月1日至2017年1月31日期間青海大學(xué)附屬醫(yī)院、青海省人民醫(yī)院收治的120例經(jīng)病理確診的肺神經(jīng)內(nèi)分泌腫瘤患者完整病歷資料,將患者的臨床病理特征(年齡、性別、吸煙狀況、臨床表現(xiàn)、組織病理及免疫組化、分期、影像特點(diǎn)、腫瘤標(biāo)志物、治療方案)進(jìn)行回顧性分析,對(duì)所有病例進(jìn)行隨訪。計(jì)數(shù)資料的描述用率或構(gòu)成比,組間率的比較采用X2檢驗(yàn);生存曲線采用Kaplan-Meier法計(jì)算,Log-Rank法進(jìn)行影響預(yù)后單因素分析,COX模型進(jìn)行影響預(yù)后多因素分析,檢驗(yàn)水準(zhǔn)α=0.05.結(jié)果:1、120例肺神經(jīng)內(nèi)分泌腫瘤患者一般特征:男性78例,女性42,男女比例為1.86:1。典型類癌15例,不典型類癌17例,大細(xì)胞神經(jīng)內(nèi)分泌癌10例,小細(xì)胞肺癌78例。年齡區(qū)間30-82歲,中位年齡58歲。吸煙者68例,均為男性,吸煙指數(shù)600者43例。腫瘤家族史者8例。腫瘤d3cm者48例,d≤3cm者72例。未見淋巴結(jié)腫大者33例,有淋巴結(jié)腫大者87例。2、臨床特征:癥狀無明顯特異性,以咳嗽發(fā)生率最高,為64.2%,其他癥狀多為呼吸系統(tǒng)常見癥狀:典型類癌、不典型類癌、小細(xì)胞肺癌常見癥狀為咳嗽、咳痰、胸悶、氣憋等。部分大細(xì)胞神經(jīng)內(nèi)分泌癌無癥狀,有癥狀者也多為呼吸系統(tǒng)常見癥狀。3、病理特征:入組患者中有腫瘤標(biāo)志物檢測(cè)報(bào)告單者共98例,13項(xiàng)腫瘤標(biāo)志物不同程度升高,以NSE、Progrp升高率最多;91例患者行免疫組化檢測(cè)且有詳細(xì)結(jié)果,80例患者行CgA檢測(cè),陽性率:37.5%。91例行SyN檢測(cè),陽性率:72.5%。58例行CD56檢測(cè),陽性率:77.6%。70例行TTF-1檢測(cè),陽性率72.8%.4、治療與預(yù)后:手術(shù)治療者50例,放、化療者97例,僅行支持治療者3例.單因素分析示:TNM分期(P=0.009)、手術(shù)(P=0.000)、放化療(P=0.025)以及組織類型(P=0.002)對(duì)生存時(shí)間有重要影響。多因素分析結(jié)果示:手術(shù)(P=0.000)、放化療(P=0.018)、組織類型(P=0.022)為影響預(yù)后獨(dú)立因素.結(jié)論:1、性別、年齡、吸煙狀況與肺神經(jīng)內(nèi)分泌腫瘤預(yù)后無關(guān)。2、肺神經(jīng)內(nèi)分泌腫瘤臨床表現(xiàn)無特殊性,需結(jié)合影像資料、腫瘤標(biāo)志物、細(xì)胞形態(tài)及免疫組化綜合診斷。TC、AC與SCLC臨床表現(xiàn)以咳嗽、咳痰、胸悶、氣憋等常見癥狀為主,部分LCNEC無癥狀。3、手術(shù)是TC、AC、LCNEC重要的治療手段之一,手術(shù)對(duì)于分期早、病灶局限的SCLC也是可選的方法之一。有淋巴結(jié)轉(zhuǎn)移的TC、AC可行放化療,放化療是SCLC首選治療方案,放化療在LCNEC也表現(xiàn)為獲益。4、肺神經(jīng)內(nèi)分泌腫瘤類型不同預(yù)后差異較大,小細(xì)胞肺癌預(yù)后最差。5、手術(shù)、放化療、組織類型是影響預(yù)后的重要因素。
[Abstract]:Objective: to investigate the clinicopathological features of neuroendocrine tumors of the lung and to analyze the relationship between clinicopathological features and prognosis. Methods: from December 1, 2014 to January 31, 2017, 120 patients with lung neuroendocrine neoplasms diagnosed pathologically in Qinghai Provincial people's Hospital and affiliated Hospital of Qinghai University were collected. The clinicopathological features (age, sex, smoking status, clinical manifestation, histopathology and immunohistochemistry, staging, imaging features, tumor markers, treatment plan) of the patients were analyzed retrospectively. All cases were followed up. The descriptive rate or composition ratio of counting data was compared by X2 test, and the survival curve was calculated by Kaplan-Meier method. The Cox model was used to analyze the multiple factors affecting the prognosis, and the test level was 偽 0.05. Results the general characteristics of 1: 120 patients with lung neuroendocrine tumors were 78 males and 42 females, with a ratio of 1.86: 1. There were 15 cases of typical carcinoid, 17 cases of atypical carcinoid, 10 cases of large cell neuroendocrine carcinoma and 78 cases of small cell lung cancer. The age range was 30-82 years old, the median age was 58 years old. There were 68 smokers, all of whom were male, and the smoking index was 600 (43 cases). 8 cases had family history of tumor. D3cm was found in 48 cases (d 鈮，

本文編號(hào)：1949152