【摘要】：目的:目前肉瘤樣肺癌為一種比較罕見惡性程度較高的腫瘤。近年來肺肉瘤樣癌發(fā)病率不斷攀升,從而引起了胸外科醫(yī)師的廣泛關(guān)注,對其臨床特征的研究已成為近年來的研究熱點。本研究擬對肺肉瘤樣癌的臨床特征進(jìn)行研究,探究臨床特征與預(yù)后的關(guān)系。方法:收集河北醫(yī)科大學(xué)第四醫(yī)院收治的手術(shù)治療的50名肺肉瘤樣癌的患者,其中男性40名,女性10名�；颊吣挲g在24-75歲之間,中位年齡為62歲�；颊叨嘁蛐亍⒈巢刻弁�,咳嗽咳痰,痰中帶血或咳血為初次癥狀前來就診。病變位于右肺上葉23例,左肺上葉11例,右肺下葉8例,左肺下葉、右肺中葉各有4例患者。全組患者影像學(xué)表現(xiàn)均為單一的孤立病灶,無遠(yuǎn)處器官的轉(zhuǎn)移。多數(shù)患者術(shù)前均未確診,為術(shù)后石蠟標(biāo)本病理確診�；颊咧�50例行手術(shù)治療,其中48例行肺葉切除術(shù),2例行全肺切除術(shù)。27例患者術(shù)后給予輔助化療,6例予以輔助放療。使用SPSS 21.0統(tǒng)計軟件對患者生存率進(jìn)行統(tǒng)計學(xué)分析。P0.05統(tǒng)計學(xué)有意義。Kaplan-Meier法進(jìn)行生存分析,Cox風(fēng)險模型對患者預(yù)后進(jìn)行單因素以及多因素分析。隨訪截止到2016年12月,中位其隨訪的時間為38個月。結(jié)果:本研究總體3年生存率約38.0%,5年生存率為14.0%。1)性別因素,5年生存率中統(tǒng)計學(xué)無差別(P=0.128)。2)年齡大于60歲組與小于等于60歲組5年生存率無統(tǒng)計學(xué)差異(P=0.731)。3)腫瘤直徑小于等于5.0cm及直徑大于5cm的患者5年生存率差異均有統(tǒng)計學(xué)意義(P=0.000)4)有無淋巴結(jié)的轉(zhuǎn)移的患者5年生存率差異有意義,統(tǒng)計學(xué)有意義(P=0.000)。5、TNM分期對預(yù)后的影響,統(tǒng)計學(xué)有意義(P=0.002)。COX比例風(fēng)險回歸單因素分析:腫瘤大小(P=0.000),淋巴結(jié)轉(zhuǎn)移情況(P=0.000),TNM分期(P=0.001)為有意義。而性別、年齡(P=0.128),(P=0.731)無統(tǒng)計學(xué)意義。Cox多因素分析中,淋巴結(jié)轉(zhuǎn)移情況(P=0.003),TNM分期(P=0.000)為獨立影響預(yù)后的因素。全組共有50名患者,對50例有隨訪條件的患者進(jìn)行跟蹤隨訪。當(dāng)中有43名患者死亡,7名患者仍在生存,其術(shù)后總體5年生存率為14.0%。結(jié)論:年齡、性別、術(shù)后5年生存率無相關(guān)意義�；颊吡馨徒Y(jié)是否轉(zhuǎn)移、TNM分期、腫瘤大小等因素對生存率有較明顯的影響。
[Abstract]:Objective: at present, sarcoid lung cancer is a rare malignant tumor. In recent years, the incidence of pulmonary sarcomatoid carcinoma has been rising, which has aroused widespread concern of thoracic surgeons, and the study of its clinical features has become a hot research topic in recent years. The purpose of this study was to study the clinical features of pulmonary sarcomatoid carcinoma and to explore the relationship between clinical features and prognosis. Methods: fifty patients with pulmonary sarcomatoid carcinoma were treated surgically in the fourth Hospital of Hebei Medical University, including 40 males and 10 females. The age of the patient was between 24 and 75 years old, with a median age of 62 years. Most of the patients came to see the doctor because of chest, back pain, cough and expectoration, sputum with blood or cough blood as the first symptom. The lesions were located in the upper lobe of the right lung (23 cases), the upper lobe of the left lung (11 cases), the lower lobe of the right lung (8 cases), the lower lobe of the left lung (4 cases) and the middle lobe of the right lung (4 cases). The imaging findings of the patients were single isolated lesions and no distant organ metastasis. Most of the patients were not diagnosed before operation, which were confirmed by pathology of paraffin specimens after operation. 50 cases were treated surgically, including 48 cases of lobectomy and 2 cases of total pneumonectomy. 27 cases were treated with adjuvant chemotherapy and 6 cases with adjuvant radiotherapy. SPSS 21.0 statistical software was used to analyze the survival rate of patients. P 0.05 was statistically significant. Kaplan-Meier method was used for survival analysis, and Cox risk model was used to analyze the prognosis of patients by univariate and multivariate analysis. The follow-up period ended December 2016, with a median follow-up period of 38 months. Results: the overall 3-year survival rate and 5-year survival rate were 38.0% and 14.0%, respectively. There was no significant difference in 5-year survival rate (P 鈮，

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