370例肺腺癌各亚型间临床及预后影响因素的比较

Comparison of Clinical Features and Prognostic Factors among Different Histological Subtypes of Lung Adenocarcinoma:An Analysis of 370 Cases

目的：根据WHO 2004年对于肺腺癌分型的最新定义标准，探讨肺腺癌各亚型之间预后的差异及预后因素。方法：收集本院2000年1月至2003年12月期间行手术治疗的370例肺腺癌患者病理切片，并对其临床资料进行回顾性分析．对患者的生存时间进行随访；采用Kaplan—Meier法计算生存率，采用COX模型进行多因素分析。结果：全组患者术后5年总体生存率25．26％，中位生存期3．89年；单因素分析结果显示：病理亚型、支气管断端是否阳性、肿瘤直径、TNM分期、T分期、N分期、术后是否行化疗、免疫治疗对全组患者总体生存率的影响有统计学意义；多因素分析显示：术后病理亚型、气管断端是否阳性，TNM分期、肿瘤直径、是否行化疗为影响患者总体生存率的独立因素。各亚型之间分析显示：单纯型细支气管肺泡癌（Bronehioloalveolar carcinoma，BAC）的5年生存率为41．30％，优于其它类型腺癌（P=0．002）；无BAC成份的各亚型腺癌的预后差异无统计学意义；含BAC的混合型腺癌预后介于前两者之间。结论：手术仍为肺腺癌的主要治疗手段；含BAC的混合型腺癌预后介于BAC与无BAC成份的其他类型腺癌，可视为独立的病理类型；术后病理亚型、气管断端是否阳性，TNM分期、肿瘤直径、化疗为影响患者总体生存率的独立因素。

Objective： To analyze the clinical features and prognostic factors of different histological subtypes of lung adenocarcinoma. Methods： Data from 370 lung adenocarcinoma patients who underwent surgical resection for pathologically supported adenocarcinoma in our hospital between 2000 and 2003 were retrospectively reviewed. The Kaplan-Meier method was used to estimate patient survival, and Cox＇s proportional hazards model was performed for multivariate analysis. Results： The 5-year overall survival rate was 25.26%, and the mean survival time was 3.89 years. In multivariate analysis, histological subtype, incised margin residual, TNM stage, tumor size, and adjuvant chemotherapy were identified as independent survival predictors. The 5-year survival rate in bronchioloalveolar adenocarcinoma （BAC） patients was 41.30%, higher than in patients with other subtypes of lung adenocarcinoma （P=0.002）. No significant difference was found in the prognosis among patients with different subtypes of adenocarcinoma without a BAC component. Conclusion： Adenocarcinoma with a BAC component is an independent subtype of lung adenocarcinoma. Its prognosis lies between those of BAC and adenocarcinoma without BAC. Histological subtype, incised margin residual, TNM stage, tumor size, and adjuvant chemotherapy are independent survival predictors.