空洞型肺鳞癌与非空洞型肺鳞癌的临床特征分析

Comparative analysis of the clinical characteristics between cavitated squamous cell lung carcinoma and noncavitated squamous cell lung carcinoma

目的:比较空洞型肺鳞癌(cavitatedsquamouscelllungcarcinoma,cSLC)和非空洞型肺鳞癌(noncavitatedsquamouscelllungcarcinoma,ncSLC)之间的临床、病理、影像和生存特征差异,探讨cSLC是否存在特殊的临床意义。方法:回顾性研究了1999～2000年间手术确诊的肺鳞癌病例,其中cSLC51例和ncSLC281例,分析其各自的临床、病理和影像特征及生存资料。结果:诊断cSLC的所需时间比ncSLC长;cSLC发生感染和体质量下降的比例高于ncSLC;cSLC组织细胞较ncSLC分化程度低,cSLC肿瘤体积大且原发肿瘤范围广,发生阻塞性肺炎的比例高;但两者在年龄、性别、吸烟史、肿瘤家族史、个人结核史、肺内分布、临床病理分期(pTNM)、淋巴结侵犯程度(N)和远处转移(M)等方面均无显著性差异;cSLC与ncSLC患者的中位生存期分别为29、35个月,前者的1、3年生存率分别为86.3%、43.1%,后者分别为91.1%、47.0%,两者在生存时间上均没有显著差异。结论:相对ncSLC,cSLC的原发肿瘤较大、分化程度低、原发肿瘤范围广、易出现阻塞性肺炎,可能因此导致诊断时间延长和体质量下降,但与ncSLC在肿瘤的pTNM分期、淋巴结侵犯(N)、远处转移(M)和生存时间等上没有显著差异,因而还没有足够证据说明cSLC是一种特殊类型的鳞癌。

Objective： To clarify whether cSLC had the special clinical significance by comparing the clinical, histological, imaging, and survival features between cavitated squamous cell lung carcinoma （cSLC） and noncavitated squamous cell lung carcinoma （ncSLC） . Methods：Retrospective analysis was performed on 332 patients with squamous cell lung carcinoma confirmed by surgery during 1999-2000. They were divided into two groups 51 patients with cSLC and 281 with ncSLC. The clinical, histological, imaging, and survival features were compared for the both groups. Results： Compared with ncSLC patients, cSLC patients needed longer diagnosis time. They had lower body mass and more frequent infection, cSLC had lower differentiation, larger volume,and wider invasion. The frequency of obstructive pneumonia was higher in cSLC patients. There was no significant difference between the two groups in age, sex, smoking history, family tumor history, personal tuberculosis history, lung distribution, clinical stage （pTNM）, lymph node invasion, and metastasis. The median survival time was 29 months for cSLC and 35 months for ncSLC, respectively. The l-year and 3-year survival rate was 86.3% and 43.1% for cSLC and 91. 1% and 47.0 % for ncSLC,respectively. No significant difference was found in survival time between the two groups. Conclusion： The primary cSLC had a larger volume, lower differentiation, and wider invasion. Obstructive pneumonia is often seen in patients with cSLC. All these features result in longer diagnosis time and lower body mass. Because no difference was found between cSLC and ncSLC in clinical stage （pTNM）, lymph node invasion （N）, metastasis （M）, and survival time, there was not enough proof to demonstrate that cSLC was a special type of squamous cell carcinoma.