58例肺大细胞癌的诊断和外科治疗

The Diagnosis and Surgical Treatment of 58 Cases of Large Cell Lung Cancer

目的:总结58例肺大细胞癌(LCLC)的诊断和外科治疗经验,探讨其临床和病理特征及影响患者生存期的相关因素。方法:对1980年至2004年在本院接受外科治疗的58例LCLC患者临床资料进行回顾性总结分析。结果:男47例,女11例,男女之比4.3:1。年龄35～73岁。58例LCLC占同期手术病理证实2754例肺癌的2.1%。Ⅰa期9例,Ⅰb期18例,Ⅱa期4例,Ⅱb期5例,Ⅲa期16例,Ⅲb期4例,Ⅳ期2例。LCLC总体术后1、3、5年生存率分别为77.6%、37.2%、29.7%,其生存率高于小细胞肺癌,但较鳞癌和腺癌低。影响预后的因素主要是TNM分期(P=0.011)、淋巴结分期(P=0.013)、手术结果(P=0.003)。结论:LCLC恶性程度高,预后差。影响LCLC术后长期生存率的重要因素为TNM分期、有无淋巴结转移、是否根治性切除肿瘤。提高早期LCLC的发现率和以外科手术为主的综合治疗是改善术后远期疗效的关键。

Objective： To summarize our experience in the diagnosis and surgical treatment of 58 cases of large eell lung cancer （LCLC）, to explore the clinical and pathological features and to investigate the factors thai intluence patient survival. Methods： Clinical data from 58 inpatients with LCLC treated in our hospital from 1980 to 2004 were retrospectively analyzed. Results： There were 47 males and 11 females, giving a male：female ratio of 4.3：1. Patienl age ranged from 35 to 73 years old. These 58 cases of LCLC comprised 2.1% of the 2,754 cases of lung cancer pathologically confirmed during that time period. According to The New TNM Classification in Lung Carcinoma （1997）. 9 eases were stage Ⅰa, 18 cases were stage Ⅰb, 4 cases were stage Ⅱa, 5 cases were stage Ⅱb, 16 cases were stage Ⅲa, 4 cases were stage Ⅲ b and 2 cases were stage Ⅳ. The total 1-year survival rate was 77.6%, the 3-year survival rate was 37.2% and the 5-year survival rate was 29.7%. The survival rate was higher than thai of small eell carcinoma and lower than that of squamous cell carcinoma and adenocarcinoma. The main prognostic factors were TNM staging（P=0.011）, N stage（P=0.013） and surgical outcome （P=0.003）. Conclusion： LCLC is a malignant disease with poor prognosis. TNM staging, lymph node metastasis and radical excision are important factors influeneing long-term survival. Early detection of LCLC, early surgical inter- vention and adjunct multi-modality treatment are effective procedures for increasing the survival rate.