【摘要】：背景與目的同時性多原發(fā)肺癌(synchronous multiple primary lung cancer,sMPLC)既往屬少見疾病,近年發(fā)病率呈持續(xù)上升趨勢,但缺乏對其大樣本的研究報道。本研究對357例s MPLC的臨床病理資料進行分析總結,籍以為臨床診斷、治療及預后提供理論依據。方法參考Martini-Melamed診斷標準和國際肺癌研究協(xié)會(International Association for the Study of Lung Cancer,IASLC)第8版腫瘤-淋巴結-轉移(tumor-node-metastasis,TNM)分期標準,對357例sMPLC的臨床病理資料進行分析。結果 357例患者中,雙原發(fā)病灶269例(75.35%),三原發(fā)病灶65例(18.21%),四原發(fā)病灶及以上者23例(6.44%),最多者為8個病灶。病灶好發(fā)于上葉,特別是右上葉(35.77%,298/833),病理類型以腺癌為主(95.56%,796/833),鱗癌次之(2.40%,20/833),腺癌亞型中以腺泡樣為主的比例較高(70.81%,313/442),分期以Ib期及以下為主(68.35%,244/357)。病理類型相同者發(fā)病率(92.72%,331/357)遠高于不同病理類型(7.28%,26/357),其中腺癌-腺癌比例較高(99.40%,329/331)。sMPLC的3年總生存率(overall survival,OS)為91.93%,5年總生存率為84.37%,多因素生存分析顯示,有吸煙史(P=0.012)、最大病灶直徑大于2 cm(P=0.027)、淋巴結轉移(P=0.015)和胸膜受累(P0.001)為影響sMPLC預后生存的獨立危險因素。結論 sMPLC好發(fā)于右上葉,以腺癌最常見,腺泡樣為主的亞型多見。吸煙史、最大結節(jié)直徑、淋巴結轉移和胸膜侵犯是影響sMPLC預后生存的獨立危險因素。早期發(fā)現(xiàn)和積極的手術可以使sMPLC患者獲得較好的預后。
[Abstract]:Background & objective simultaneous multiple primary lung cancer (synchronous multiple primary lung cancer MPLC) is a rare disease in the past. The incidence of MPLCs has been increasing in recent years, but there is no report on its large sample. In this study, the clinicopathological data of 357 cases of s MPLC were analyzed and summarized to provide theoretical basis for clinical diagnosis, treatment and prognosis. Methods according to the diagnostic criteria of Martini-Melamed and tumor-node-lymph node metastasis (TNM) staging criteria of (International Association for the Study of Lung Cancer IASLC, the clinicopathological data of 357 cases of sMPLC were analyzed. Results among 357 patients, 269 cases (75.35%) had double primary lesions, 65 cases (18.21%) had three primary lesions, 23 cases (6.44%) had four or more primary lesions, and 8 lesions were the most common. The lesions mainly occurred in the upper lobe, especially in the right superior lobe (35.7778 / 833). The pathological types were mainly adenocarcinoma (95.56A / 796 / 833), squamous cell carcinoma (2.40C / 20 / 833), acinar subtype (70.81313 / 442), and stage Ib (68.35 / 24447). The incidence rate of the same pathological type (92.72and 331- 357) was much higher than that of the different pathological types (7.280.26 / 357), in which the ratio of adenocarcinoma to adenocarcinoma was higher (99.4040 / 329 / 331) .sMPLC had a overall survival OS of 91.93, and a 5-year overall survival rate of 84.377.Multivariate survival analysis showed that Smoking history (P0. 012), maximum lesion diameter more than 2 cm (P0. 027), lymph node metastasis (P0. 015) and pleural involvement (P0. 001) were independent risk factors for the survival of sMPLC. Conclusion sMPLC usually occurs in the upper right lobe, adenocarcinoma is the most common and acinar subtype is more common. Smoking history, maximum nodule diameter, lymph node metastasis and pleural invasion were independent risk factors for survival of sMPLC. Early detection and active surgery can lead to better prognosis in patients with sMPLC.
【作者單位】： 上海交通大學附屬胸科醫(yī)院/上海市肺部腫瘤臨床醫(yī)學中心;
【分類號】：R734.2

【參考文獻】

相關期刊論文 前3條

1 郭海法;申屠陽;;多原發(fā)肺癌的診斷和處理策略新進展[J];中國肺癌雜志;2016年05期

2 李營;金波;施建新;張巖巍;吉春宇;韓寶惠;;41例可手術多原發(fā)肺癌臨床分析[J];中國癌癥雜志;2014年09期

3 張雷,李文濤,丁嘉安,高文;多原發(fā)性肺癌的外科治療[J];中華胸心血管外科雜志;2004年01期

【共引文獻】

相關期刊論文 前10條

1 何冰杰;王曉燕;余麗君;王亞娥;楊文華;;心理支持護理對肺癌術后化療患者自我感受負擔和生活質量的影響[J];中國腫瘤臨床與康復;2017年01期

2 郭海法;毛鋒;張輝;裘楊波;申屠陽;;同時性多原發(fā)肺癌的預后及生存相關因素研究[J];中國肺癌雜志;2017年01期

3 段晉;施云飛;雷又鳴;趙煒;張倩;;雙原發(fā)肺癌的胸外科治療結局和長期生存率探討[J];中外醫(yī)療;2016年36期

4 王輝;王曉軍;陳樹;郭喜平;;雙原發(fā)性肺癌的臨床診治進展[J];中國胸心血管外科臨床雜志;2016年07期

5 郭海法;申屠陽;;多原發(fā)肺癌的診斷和處理策略新進展[J];中國肺癌雜志;2016年05期

6 侯晶晶;王慧娟;張國偉;馬智勇;;多原發(fā)肺癌的診斷與治療[J];中國肺癌雜志;2015年12期

7 何玉麟;占潔;龔洪翰;王敏;肖香佐;曾小紅;;多原發(fā)性肺癌的CT診斷[J];實用放射學雜志;2015年09期

8 李建東;;微創(chuàng)胸腔鏡與傳統(tǒng)開胸手術治療肺癌的療效觀察[J];中國繼續(xù)醫(yī)學教育;2015年14期

9 梁穎;戚靜燕;歸兼健;李亞;葉春;;鮮鐵皮石斛對肺癌患者睡眠及心理狀況影響的研究[J];中華中醫(yī)藥學刊;2015年06期

10 鐘成誠;鐘龍;劉建國;楊永杰;;支氣管動脈灌注化療+栓塞術聯(lián)合放射性~(125)I粒子植入術治療原發(fā)性肺癌的臨床療效觀察[J];實用心腦肺血管病雜志;2015年04期

【二級參考文獻】

相關期刊論文 前6條

1 姜格寧;;多病灶肺癌的外科診治[J];外科研究與新技術;2013年03期

2 何萍;顧霞;關玉寶;姚廣裕;林云恩;何建行;;同時性多中心原發(fā)性肺癌37例臨床病理分析[J];中華腫瘤防治雜志;2013年05期

3 ;Cancer Incidence and Mortality in China,2007[J];Chinese Journal of Cancer Research;2012年01期

4 周麗娜;吳寧;李蒙;;多層螺旋CT對同時多原發(fā)肺癌的診斷價值[J];癌癥進展;2012年01期

5 張雷,李文濤,丁嘉安,高文;多原發(fā)性肺癌的外科治療[J];中華胸心血管外科雜志;2004年01期

6 孫怡芬;胡培安;劉涌;胡瑛;李寶蘭;馬s，

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