原发性支气管类癌的手术治疗与预后分析

Outcome and Surgical Strategy in Primary Bronchial Carcinoid Tumors

目的总结支气管类癌的临床特点、诊断、方法手术治疗及疗效,评价预后影响因素。方法回顾性分析原发性支气管类癌58例患者的临床资料,根据最新2004年WHO肺癌病理组织学分类标准分为典型类癌(typicalcarci-noid,TC)和非典型类癌(atypical carcinoid,AC),并根据1997年国际抗癌联盟(UICC)肺癌分期标准进行TNM分期。结果58例患者均行手术治疗加淋巴结清扫术(97年以前行淋巴结采样切除术,98后行系统性淋巴结清扫术),无围手术期死亡病例。影像类型、病灶大小与临床分期有统计学意义(P<0.05)。支气管类癌术后总体5年、10年生存率分别为75.0%、68.5%,TC预后明显优于AC(5年和10年生存率分别为90.8%、81.2%和52.7%、52.7%,P<0.05),N0期预后明显优于N1+N2期(5年、10年生存率分别为82.6%、75.0%和40.7%,P<0.05)。Log-rank单因素分析显示临床分期、影像类型、病灶大小、术后放化疗及复发亦对预后有影响(P均<0.05)。COX多因素分析显示病理类型、N分期是预后最主要的影响因素。结论支气管类癌的临床症状缺乏特征性改变,诊断最终需要组织病理学依据,支气管镜活组织检查对临床诊断有重要作用,刷片、痰脱落细胞学检查则无诊断意义。病理类型、N分期是重要预后因素。

Objective To evaluate the clinical characteristics, diagnosis, surgery treatment,long-time survival and factors influencing outcome in bronchial carcinoid tumor, Methods 58 patients with bronchial carcinoid tumor were retrospectively reviewed, All cases were reviewed and classified as typical carcinoid （TC） or atypical carcinoid （AC） according to WHO criteria （2004）. Results All patients received surgery and lymphadenectomy （lymph-sampling before 1997, and systematic lymphadenectomy since 1998, No treatment related death during the peroperative period. Radiological types and tumor size were significantly correlated with the clinical stages （ P 〈 0.05 ）, Overall 5,10-years survival rate was 75, 0% and 68, 5 %. TC showed a more favourable prognosis than AC （5,10-years survival rate were 90.8% ,81.2% and 52.7% ,52.7% ,respectively ;P 〈0.05） as well as NO patients in comparison with N1 ＋ N2 patients （5,10-years survival rate were 82.9% ,75, 0% and 40.7% ,respectively;P 〈 0.05 ）. Univariate analysis showed that clinical stage, radiologlcal type, tumor size, postoperative radiotherapy or chemotherapy and relapses were also the significant prognostic factor （ P 〈 0.05 ）. Cox regression analysis showed pathological type and N stage were the most important significant prognostic factor. Conclusion There were not distinctively clinical characteristics in bronchial carcinoid tumor. Diagnosis could only be made after pathological examinations of the tissue samples from endoscopic biopsy, whereas bronchial brushing and exfoliative cytology have no diagnostic values, Pathological type, N stage were the most important significant prognostic factor in bronchial carcinoid tumor.