非小细胞肺癌新亚型分类的临床意义

Clinical significance of new classification of subtypes of non-small cell lung cancer

目的：明确非小细胞肺癌（non-small cell lung cancer，NSCLC）中细支气管肺泡细胞癌（bronchioloalveolar carcinoma，BAC）成分与临床治疗和预后的相关性。方法：收集上海市胸科医院随访资料完整的386例NSCLC病例（pTNMⅠ～Ⅲ期），其中男性275例，女性111例。按WHO2004年版肺癌病理学分类标准重新核对组织病理学亚型，分组：鳞癌、腺癌、腺癌＋BAC、腺鳞癌、腺鳞癌＋BAC、其他（大细胞癌、肉瘤样癌）。结果：NSCLC伴有BAC成分占NSCLC总数的21．8％；鳞癌占31．6％，腺癌占36．8％（其中1／2伴BAC成分），腺鳞癌占16．6％（其中1／5伴BAC成分），其他亚型占15．0％。统计学分析表明NSCLC分为这6个新亚型与pTNM分期有相关性（P〈0．05），在Ⅰ期NSCLC中以鳞癌和含有BAC成分的腺癌较多见。通过Kaplan-Meier生存曲线的进一步分析，发现含有BAC成分的复合型NSCLC的预后要优于其单纯型，生存期有显著的统计学差异（P〈0．05）；本组病例预后最好的是腺癌伴BAC成分，其余依次为鳞癌、腺鳞癌伴BAC成分、腺癌、其他亚型和腺鳞癌。结论：首次明确了腺鳞癌伴BAC成分的临床意义，提示NSCLC伴有BAC成分预后较好，NSCLC亚型的新分类具有独立的预后意义，可为探讨NSCLC治疗的新方案提供思路。

Objective： To definite the components of bronchioalveolar cell carcinoma （BAC） in non-small cell lung cancer （NSCLC） and investigate their association with clinical therapy and prognosis. Methods： The complete follow-up data from 386 NSCLC patients were collected in Shanghai Chest Hospital. All the patients were in stage Ⅰ to Ⅲ according to pTNM classification , which included 275 males and 111 females. Pathological classification was revised according to WHO Classification of Lung Tumours （2004）. Three slides were used for every patient. NSCLCs were divided into six subgroups： squamous cell carcinoma, , adenocarcinoma＋BAC, adenosquamous carcinoma, adenosquamous carcinoma ＋ BAC, and others （large cell carcinoma and sarcomatoid carcinoma）. Results.. NSCLC with BAC component accounted for 21.8% of the whole NSCLC, of which 31.6 % were squamous cell carcinoma, 36.8 % were adenocarcinoma （1/2 had BAC component）, and 16. 6 % were adenosquamous carcinoma （1/5 had BAC component）, and 15.0% were other carcinomas. Statistical analysis demonstrated that the new 6 subgroups had significant correlation with pTNM stages（P〈0.05）. Patients with adenocarcinoma＋BAC component had best prognosis. The order of prognosis was adenocarcinoma＋BAC component〉squamous cell carcinoma〉adefiosquamous carcinoma＋ BAC component〉adenocarcinoma〉other subtypes〉 adenosquamous carcinoma. Kaplan-Meier analysis suggested that patients with NSCLC＋BAC component had longer survival time and better prognosis than those with simple NSCLC（P〈0.05 Conclusion： Patients with combined NSCLCs ＋ BAC component have better prognosis, of which adenosquamous carcinoma ＋ BAC has better prognosis than simple one was demonstrated firstly. New classification of the subtypes of NSCLC （squamous cell carcinoma, adenocarcinoma, adenocarcinoma ＋ BAC, adenosquamous carcinoma, adenosquamous carcinoma ＋ BAC, ers） has independent prognostic significance, which provides a new idea for NSCLC therapy.