慢性阻塞性肺疾病合并肺癌64例临床分析

Clinical analysis of 64 cases of chronic obstructive pulmonary disease accompanied by lung cancer

目的探讨慢性阻塞性肺疾病（COPD）合并肺癌的临床特征、诊断、治疗及预后。方法对64例COPD合并肺癌患者的临床资料进行回顾性分析。结果COPD合并肺癌患者多数为老年人。平均年龄72．6岁，其中男性53例（82．8％），女性11例（17．2％），吸烟者多见（52例，81．3％）。临床表现均有咳嗽、咳痰，此外，以胸痛（11例，17．2％）、咯血或痰中带血（26例，40．6％）、进行性消瘦（51例，79．7％）、胸闷、呼吸困难（22例，34．4％）等为主；影像学表现示中心型肺癌49例（76．6％），周围型肺癌15例（23．4％）；病理类型以鳞癌（37例，57．8％）为主，其次为腺癌（14例，21．9％）；TNM分期以Ⅲ期（36例，56.3％）、Ⅳ期（23例，35．9％）为主；手术治疗12例，化疗15例，姑息治疗37例；10例患者存活（15．6％），其中存活2年以上4例（6-3％），51例死亡（79．7％），其中6个月内死亡21例（32．8％），7～12个月内死亡22例（34．4％），13-24个月内死亡8例（12．5％）。失访3例（4．7％）。结论COPD合并肺癌患者多数为老年、男性、吸烟者，以Ⅲ、Ⅳ期为主，以对症、支持、化疗为主，预后差，对于COPD且重度吸烟者要列为肺癌高危人群，应定期检查，以期提高早期诊断率。

[Objective] To explore the clinical feature, diagnosis, treatment and prognosis of chronic obstructive pulmonary disease （COPD） accompanied by lung cancer. [Methods] The clinical data of 64 cases of COPD with lung cancer were analyzed retrospectively. [Results] The majority of COPD with lung cancer patients were aged people, with an average age of 72.6, including 53 cases of men （82.8%） and 11 female patients （17.2%）, smokers were commonly （52 cases, 81.3%）. They all had cough, expectoration. In addition, chest pain （n = 11, 17.2%）, hemoptysis （n = 26, 40.6%）, and increasing marcor （51 cases, 79.7%）, chest distress and dyspnea （22 cases, 34.4%）. The main imaging findings showed central lung cancer was 49 cases （76.6%）, peripheral lung cancer 15 cases （23.4%）. For pathological types, squamous carcinoma was 37 cases （57.8%）, followed by adenoeareinoma （14 cases, 21.9%）. The TNM stage was mainly stage 111 （36 cases, 56.3%） and stage 1V （23＂ cases, 35.9%）. For treatment, surgical treatment 12 cases, chemotherapy 15 cases, alleviative treatment 37 cases. 10 patients （15.6%） survived, in which four cases （6.3%） survived more than 2 years. 51 cases died （79.7%）, in which 21 cases （32.8%） died within 6 months, 22 patients （34.4%） died within 7 to 12 months, 8 cases （12.5%） died within 13 to 24 months. 3 cases （4.7%） were lost follow up. [Conclusions] The patients of COPD with lung cancer were mainly aged people, male and smokers, mainly stage Ⅲ -Ⅳ to symptomatic. Alleviative treatment and chemotherapy were the main treatment, the prognosis is poor, The severe COPD with smokers were high-risk groups of lung cancer, should be regularly inspected, so as to improve the early diagnosis.