【摘要】：目的:分析原發(fā)性肺鱗癌與肺腺癌在臨床癥狀、血清腫瘤標(biāo)志物、血液高凝狀態(tài)相關(guān)指標(biāo)、影像學(xué)特征、PET/CT(Positron Emission Computed Tomography/Computed Tomography,正電子發(fā)射斷層顯像/X射線斷層掃描技術(shù))表現(xiàn)等方面的差異,探討肺鱗癌與肺腺癌臨床特點(diǎn)的差異,并分別對肺鱗癌及肺腺癌原發(fā)灶SUVmax(Maximum standard uptake value,最大標(biāo)準(zhǔn)攝取值)與腫瘤大小及其TNM分期進(jìn)行相關(guān)性分析。方法:回顧性分析西南醫(yī)科大學(xué)附屬醫(yī)院2013年1月-2016年5月期間考慮為肺癌收入院的患者,通過手術(shù)、可彎曲支氣管鏡、內(nèi)科胸腔鏡、經(jīng)皮肺穿刺、淋巴結(jié)穿刺等方法取得的組織學(xué)或細(xì)胞學(xué)標(biāo)本,經(jīng)病理檢查及免疫組化確診為原發(fā)性非小細(xì)胞肺癌的患者,并完善PET/CT檢查者,按病理類型將其分為肺鱗癌及肺腺癌兩組,分析比較兩種不同病理類型肺癌患者的性別、年齡、吸煙與否、臨床癥狀(咳嗽、胸痛、咯血、呼吸困難、發(fā)熱、體重下降等)、血清腫瘤標(biāo)志物CEA(Carcino-embryonic antigen,癌胚抗原)、NSE(Neuron-specific enolase,神經(jīng)元特異性烯醇化酶)、CA125(Carbohydrate antigen 125,糖類抗原125)、SCCA(Squamous cell carcinoma antigen,鱗狀細(xì)胞癌相關(guān)抗原)及CYFRA-21-1(Cytokeratin 19 fragment,細(xì)胞角蛋白19片段)、血液高凝狀態(tài)指標(biāo)D-二聚體、Fib(Fibrinogen,血漿纖維蛋白原)、血小板計(jì)數(shù)、原發(fā)病灶胸部CT的影像學(xué)特點(diǎn)(有無分葉征、毛刺征、胸膜牽拉征、肺不張、支氣管狹窄、阻塞性肺炎等)、原發(fā)灶大小、PET/CT中SUVmax值大小等方面的差異;對肺鱗癌組及肺腺癌組原發(fā)灶SUVmax與其腫瘤病灶大小作相關(guān)性分析,并按原發(fā)灶大小分別將肺鱗癌及肺腺癌組分為三個亞組(原發(fā)灶直徑≤3cm亞組、3cm且≤7cm亞組、7cm亞組),分析三個亞組間原發(fā)灶SUVmax之間的差異,分別將肺鱗癌及肺腺癌原發(fā)灶SUVmax與TNM分期作相關(guān)性分析。結(jié)果:1.一般情況:納入病例總數(shù)259例,其中肺鱗癌組116例,肺腺癌組143例;肺腺癌組的性別百分比分別是男51.7%(74例)、女48.3%(69例),肺鱗癌組的性別比例為男94.0%(109例),女6.0%(7例),兩組間的性別構(gòu)成差異具有統(tǒng)計(jì)學(xué)意義(P0.05);肺腺癌組中最小年齡29歲,最大年齡80歲,平均年齡(57.2±11.0)歲,肺鱗癌組中最小年齡37歲,最大年齡83歲,平均年齡(58.4±9.4)歲,兩組間年齡構(gòu)成比無明顯差異;肺鱗癌組的吸煙患者數(shù)101例(87.1%)、肺腺癌組吸煙患者數(shù)58例(40.5%),肺鱗癌組吸煙率高于肺腺癌組(P0.05)。2.臨床癥狀:肺鱗癌組中咳嗽99例(85.3%)、咯血50例(43.1%)、呼吸困難53例(45.7%)、體重下降例49(42.2%),肺腺癌組中咳嗽103例(72.0%)、咯血35例(24.5%)、呼吸困難37例(25.9%)、體重下降例41(28.7%),肺鱗癌組中臨床癥狀(咳嗽、咯血、呼吸困難、體重下降)占比高于肺腺癌組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.血清腫瘤標(biāo)志物:肺鱗癌組患者血清腫瘤標(biāo)志物的含量為:CEA(9.16±18.35)ng/ml、NSE(11.91±10.39)ng/ml、CA125(48.78±108.24)IU/ml、SCCA(11.18±30.57)IU/ml、CYFRA-21-1(9.23±15.25)ng/ml,肺腺癌組患者血清腫瘤標(biāo)志物的含量為:CEA(24.27±36.37)ng/ml、NSE(10.61±9.08)ng/ml、CA125(140.09±250.65)IU/ml、SCCA(1.29±2.86)IU/ml、CYFRA-21-1(6.16±14.71)ng/ml,在上述血清腫瘤標(biāo)志物中肺腺癌組患者血清的CEA及CA125含量高于肺鱗癌組、SCCA及CYFRA-21-1的含量低于肺鱗癌組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.血液高凝狀態(tài)相關(guān)指標(biāo):肺腺癌組患者血液中D-二聚體含量為(1.66±2.51)ug/ml,高于肺鱗癌組患者(0.59±0.49)ug/ml,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);血小板含量在肺鱗癌組及肺腺癌組患者間無明顯差異(P0.05),分別為(297.36±93.21)×109/L、(288.46±89.56)×109/L;肺鱗癌及肺腺癌的Fib(血漿纖維蛋白原)含量亦無明顯差異,分別為(4.32±1.28)g/L、(4.47±1.42)g/L(P0.05)。5.影像學(xué)方面:肺鱗癌組中原發(fā)灶存在分葉征者有67例(57.8%)、毛刺征20例(17.2%)、胸膜牽拉征40例(34.5%)、阻塞性肺不張41例(35.3%)、阻塞性肺炎39例(33.6%)、空泡征12例(10.3%)、氣管腔狹窄57例(49.1%),肺腺癌組中原發(fā)灶具有分葉征者88例(61.5%)、毛刺征32例(22.4%)、胸膜牽拉征82例(57.3%)、阻塞性肺不張18例(12.6%)、阻塞性肺炎17例(11.9%)、空泡征15例(10.5%)、氣管腔狹窄阻塞36例(25.2%),其中肺鱗癌組原發(fā)灶具有阻塞性肺不張、阻塞性肺炎、氣管腔狹窄征象的比例高于肺腺癌組,具有胸膜牽拉征象的比例低于肺腺癌組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);肺鱗癌組原發(fā)灶直徑為(5.15±2.40)cm,大于肺腺癌組原發(fā)灶直徑(3.73±2.10)cm,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);肺鱗癌原發(fā)灶SUVmax值為(13.22±4.92),高于肺腺癌(8.94±4.06)(P0.05),但在不同原發(fā)灶大小三亞組間,僅當(dāng)病灶直徑≤3cm時,肺鱗癌原發(fā)灶SUVmax較肺腺癌大。6.在相關(guān)性分析中:肺鱗癌組原發(fā)灶SUVmax與其原發(fā)灶大小呈顯著正相關(guān),其相關(guān)系數(shù)為0.31(P=0.008),肺腺癌組原發(fā)灶SUVmax與其原發(fā)灶大小亦呈顯著正相關(guān),其相關(guān)系數(shù)0.41(P=0.000);肺鱗癌原發(fā)灶SUVmax與T分期的顯著相關(guān),相關(guān)系數(shù)為0.324(P=0.005)、與N分期及M分期無明顯相關(guān),其相關(guān)系數(shù)分別為0.066(P=0.581)、0.046(P=0.699);肺腺癌的原發(fā)灶SUVmax與T分期的相關(guān)系數(shù)為0.479(P=0.000)、與N分期的相關(guān)系數(shù)為0.268(P=0.011)、與M分期的相關(guān)系數(shù)為0.262(P=0.013)其原發(fā)灶SUVmax與T分期、N分期、M分期均相關(guān)。結(jié)論:1.肺鱗癌患者中男性比例及吸煙率高于肺腺癌患者,肺鱗癌與肺腺癌患者年齡構(gòu)成無明顯差異;2.肺鱗癌患者臨床癥狀(咳嗽、咯血、呼吸困難、體重下降)的發(fā)生率高于肺腺癌患者;3.肺腺癌患者血清CEA及CA125含量高于肺鱗癌患者,SCCA及CYFRA-21-1的含量低于肺鱗癌患者;4.肺腺癌患者血清中D-二聚體可能高于肺鱗癌患者,肺腺癌及肺鱗癌患者血液中的血小板含量及Fib濃度無明顯差異;5.肺鱗癌患者胸部CT表現(xiàn)為阻塞性肺不張、阻塞性肺炎、氣管腔狹窄的比例高于肺腺癌患者,肺腺癌患者胸膜牽拉征比例高于肺鱗癌患者;肺鱗癌患者原發(fā)灶大小高于肺腺癌患者,當(dāng)原發(fā)灶直徑≤3cm時,肺鱗癌患者原發(fā)灶SUVmax值高于肺腺癌患者;6.肺鱗癌組與肺腺癌組SUVmax高低均與原發(fā)灶大小顯著正相關(guān),均表現(xiàn)為原發(fā)灶直徑越大,其SUVmax值越高;肺鱗癌組SUVmax高低與T分期顯著相關(guān),前者越高,T分期越高,但其與N分期、M分期無明顯相關(guān);肺腺癌組SUVmax高低與T分期、N分期、M分期均顯著相關(guān),SUVmax越高,分期越晚。
[Abstract]:Objective: to analyze the clinical symptoms of primary lung squamous cell carcinoma and lung adenocarcinoma in clinical symptoms, serum tumor markers, blood hypercoagulable state, imaging features, PET/CT (Positron Emission Computed Tomography/Computed Tomography, /X ray tomography of positron emission tomography), and to explore lung squamous cell carcinoma and lung adenocarcinoma. The difference in clinical characteristics, and the correlation analysis of SUVmax (Maximum standard uptake value, maximum standard intake) and tumor size and TNM staging of the primary lung cancer and lung adenocarcinoma. Methods: a retrospective analysis was carried out in the Affiliated Hospital of Southwest Medical University in May January 2013, which was considered as a lung cancer income hospital. Surgery, bendable bronchoscopy, internal medical thoracoscopy, percutaneous lung puncture, lymph node puncture and other histological or cytological specimens, confirmed by pathological examination and immunohistochemistry, were diagnosed as primary non-small cell lung cancer and were perfected by PET/CT, divided into two groups of lung squamous cell carcinoma and lung adenocarcinoma according to pathological types, analysis and comparison of two different types. Sex, age, smoking or not, clinical symptoms (coughing, chest pain, hemoptysis, dyspnea, fever, weight loss, etc.), serum tumor markers CEA (Carcino-embryonic antigen, carcinoembryonic antigen), NSE (Neuron-specific enolase, deity specific enolase), CA125 (Carbohydrate antigen 125, saccharide antigen 125), S, S, and S, S. CCA (Squamous cell carcinoma antigen, squamous cell carcinoma associated antigen) and CYFRA-21-1 (Cytokeratin 19 fragment, cytokeratin 19 fragment), blood hypercoagulable state index D- two polymer, Fib (Fibrinogen, plasma fibrinogen), platelet count, the imaging characteristics of the primary focus of the chest CT (without lobular sign, burr sign, pleural stretch sign, Pulmonary atelectasis, bronchostenosis, obstructive pneumonia, etc., the size of primary foci and the size of SUVmax in PET/CT; the correlation between the primary SUVmax and the tumor size of the lung squamous cell carcinoma group and the lung adenocarcinoma group was analyzed, and the lung squamous cell carcinoma and the lung adenocarcinoma group were divided into three subgroups according to the size of the primary foci (primary diameter less than 3cm subgroup, 3cm The difference between the primary foci of the three subgroups and the difference between the primary SUVmax of the three subgroups was analyzed, and the correlation between the SUVmax and the TNM staging of the lung squamous cell carcinoma and the lung adenocarcinoma was analyzed. Results: 1. general cases were included in 259 cases, including 116 cases of lung squamous cell carcinoma, 143 cases of lung adenocarcinoma group, and 51.7% of the sex of lung adenocarcinoma group (74 cases). Female 48.3% (69 cases), the sex ratio of the lung squamous cell carcinoma group was 94% (109 cases) and 6% (7). The difference between the two groups was statistically significant (P0.05). The minimum age of the lung adenocarcinoma group was 29 years old, the maximum age was 80 years, the average age was (57.2 + 11) years, the minimum age of the lung squamous cell carcinoma was 37 years, the maximum age was 83 years, the average age (58.4 + 7) years old. There were no significant differences in the age composition ratio among the groups; the number of smokers in the lung squamous cell carcinoma group was 101 (87.1%), the number of smoking patients in the lung adenocarcinoma group was 58 (40.5%). The smoking rate of the lung squamous cell carcinoma group was higher than that of the lung adenocarcinoma group (P0.05).2. clinical symptoms: 99 cases of coughing in the lung squamous cell carcinoma group (85.3%), 50 cases of hemoptysis (43.1%), 53 cases of dyspnea (45.7%), weight decline case 49 (42.2%), lung adenocarcinoma group There were 103 cases of coughing (72%), 35 cases of hemoptysis (24.5%), 37 cases of dyspnea (25.9%), and 41 (28.7%) of weight loss. The ratio of clinical symptoms (coughing, hemoptysis, dyspnea, weight loss) in the lung squamous cell carcinoma group was higher than that in the lung adenocarcinoma group, and the difference was statistically significant (P0.05).3. serum tumor markers: the serum tumor markers in the lung squamous cell carcinoma group were CEA (9.16 + 18.35) ng/ml, NSE (11.91 + 10.39) ng/ml, CA125 (48.78 + 108.24) IU/ml, SCCA (11.18 + 30.57) IU/ml, CYFRA-21-1 (9.23 + 15.25) ng/ml. The content of the serum tumor markers in the lung adenocarcinoma group was CEA (24.27 + 36.37) ng/ml. The serum levels of CEA and CA125 in the lung adenocarcinoma group were higher than those in the lung squamous cell carcinoma group, and the content of SCCA and CYFRA-21-1 was lower than that of the lung squamous cell carcinoma group, and the difference was statistically significant (P0.05).4. blood hypercoagulable state related index: the content of D- two polymer in the blood of the lung adenocarcinoma group was (1.66 + 2.51) ug/ml, higher than that of the lung squamous cell carcinoma group (0.5 9 + 0.49) ug/ml, the difference was statistically significant (P0.05); there was no significant difference in the platelet content between the lung squamous cell carcinoma group and the lung adenocarcinoma group (P0.05), respectively (297.36 + 93.21) x 109/L, (288.46 + 89.56) x 109/L, and there was no significant difference between the lung squamous cell carcinoma and the lung adenocarcinoma (4.32 + 1.28) g/L, (4.47 + 1.42) g/L (P0), respectively. .05).5. imaging: there were 67 cases (57.8%), 20 cases of burr sign (17.2%), 40 cases of pleural stretch sign (34.5%), 41 cases of obstructive pulmonary atelectasis (35.3%), 39 obstructive pulmonary disease (33.6%), 12 cases of obstructive pulmonary disease (10.3%), pneumonoid stenosis in 57 cases (33.6%), and lobular syndrome in the lung adenocarcinoma group, and hair in the lung adenocarcinoma group. 32 cases (22.4%), 82 cases (57.3%) of pleural stretch sign, 18 cases of obstructive pulmonary atelectasis (12.6%), 17 cases of obstructive pneumonia (11.9%), 15 cases of vacuoles syndrome (10.5%) and 36 cases of tracheal stenosis obstruction (25.2%), of which the primary foci in the lung squamous cell carcinoma group were obstructive pulmonary atelectasis, obstructive pneumonia, and the proportion of tracheal stenosis was higher than that of lung adenocarcinoma group, with pleural traction. The proportion of the signs was lower than that in the lung adenocarcinoma group (P0.05), the primary focal diameter of the lung squamous cell carcinoma group was (5.15 + 2.40) cm, which was greater than that of the lung adenocarcinoma group (3.73 + 2.10) cm, and the difference was statistically significant (P0.05). The SUVmax value of the lung squamous cell carcinoma was (13.22 + 4.92), higher than that of lung adenocarcinoma (8.94 + 4.06) (P0.05), but in different primary foci Between the size and size of the Sanya group, when the lesion diameter was less than 3cm, the primary SUVmax of the lung squamous cell carcinoma was compared with the large.6. of the lung adenocarcinoma. The primary focus of SUVmax in the lung squamous cell carcinoma group was significantly positively correlated with the size of the primary foci, and the correlation coefficient was 0.31 (P=0.008). The primary focal size of the lung adenocarcinoma group was also positively correlated with the size of the primary focal lesion, and the correlation coefficient was 0.41. (P=0.000): the correlation coefficient of SUVmax and T staging was 0.324 (P=0.005), and the correlation coefficient was 0.066 (P=0.581) and 0.046 (P=0.699), respectively. The correlation coefficient between SUVmax and T staging of lung adenocarcinoma was 0.479 (P=0.000), and the correlation coefficient with N stage was 0.268. The correlation coefficient of the staging was 0.262 (P=0.013) SUVmax and T staging, N staging and M staging. Conclusion: the male proportion and smoking rate in 1. lung squamous cell carcinoma patients were higher than those of lung adenocarcinoma, and there was no significant difference in age composition between lung squamous cell carcinoma and lung adenocarcinoma patients; 2. patients with lung squamous cell carcinoma were associated with bed symptoms (cough, hemoptysis, dyspnea, weight loss). The levels of serum CEA and CA125 in 3. patients with lung adenocarcinoma were higher than those of lung squamous cell carcinoma, and the content of SCCA and CYFRA-21-1 was lower than that of lung squamous cell carcinoma. The serum D- two polymer in the serum of 4. lung adenocarcinoma patients may be higher than that of lung squamous cell carcinoma, and the blood small plate content and Fib concentration in the blood of the lung adenocarcinoma and lung squamous cell carcinoma patients have no significant difference; 5. lung squamous cell carcinoma patients The proportion of CT in the chest was obstructive pulmonary atelectasis, obstructive pneumonia, and the proportion of tracheal stenosis was higher than that of lung adenocarcinoma. The proportion of pleural traction in lung adenocarcinoma patients was higher than that of lung squamous cell carcinoma; the primary focal size of lung squamous cell carcinoma was higher than that of lung adenocarcinoma. When the primary diameter was less than 3cm, the SUVmax value of the primary lung cancer patients was higher than that of the lung adenocarcinoma patients; 6. lung squamous cell scale was higher than that of the lung adenocarcinoma. The high and low levels of SUVmax in the cancer group and the lung adenocarcinoma group were significantly correlated with the size of the primary focus, the higher the diameter of the primary focus, the higher the SUVmax value. The higher the SUVmax level in the lung squamous cell carcinoma group was associated with the T staging. The higher the former, the higher the T stage, but it was not associated with the N staging, M staging, and the level of SUVmax in the lung adenocarcinoma group was significantly different from the T staging, N staging, M staging. The higher the SUVmax, the later the stages are.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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