22例肺基底细胞样鳞癌临床特点分析

Clinical Analysis of 22 Cases of Basaloid Squamous Carcinoma

目的：探讨肺基底细胞样鳞癌（basaloid squamous carcinoma of the lung，BSC）的临床特点及预后相关因素，比较与低分化鳞癌（poorly differentiated squamous cell carcinoma，PDSC）的生存差异。方法：收集我院2004年1月至2008年12月的BSC及PDSC病例，进行病理切片复习，确诊后对其临床资料进行对比分析。结果：与PDSC组相比，BSC患者除女性患病比例较高（P=0．001）和男性吸烟量较大（P=O．003）外，在其他人口学特征和临床特征方面差异无统计学意义。BSC和PDSC组生存率无明显差异（Х^2=0．03，P=0．547），两组中位生存时间分别为19个月和30个月，4年生存率分别为22．4％和36．1％（u=0．740，P=0．230）。对于Ⅰ期和Ⅱ期患者，两组生存率也无明显差异（Х^2=1．09，P=0．2974），两组中位生存时间分别为19个月和46个月，4年生存率分别为47.3％和45．2％（u=0．122，P=0．450）。不考虑病理类型，经Cox比例风险模型分析发现，手术方式和临床分期与患者预后相关，与实施肺叶切除者相比，全肺切除者术后死亡风险增加1．379倍（P=0．031），局部切除者死亡风险增加1．634倍，但未达到统计学意义（P=0．061）；随临床分期增加，发生术后死亡的风险比增高（Х^2=14．12，P=0．000），Ⅲ～Ⅳ期患者发生术后死亡的风险是Ⅰ期患者的2．347倍（P=0．018），Ⅰ期和Ⅱ期患者术后的死亡风险无统计学差异（P=0．057）。结论：BSC女性发生率高于PDSC，未发现BSC的预后同PDSC存在差异，因此，暂时不需要对此类特殊非小细胞肺癌亚型设定不同的治疗模式。

Objective： To discuss the clinical features of basaloid squamous carcinoma （BSC） and the factors relating to its prognosis and to compare patient survival between poorly differentiated squamous call carcinoma （PDSC） and BSC. Methods： Clinical and pathological data of BSC and PDSC cases seen in our hospital between January 2004 and December 2008 were reviewed. Results： There were no statistical differences in demographic and clinical features between PDSC and BSC patients, with the exception that a larger proportion of BSC patients were female （P=0.001）. Additionally, higher tobacco consumption was observed among BSC male patients （P=0.003）. There were no significant differences in survival rate between BSC and PDSC groups （Х^2=0.03, P=0.5470）. The median survival time of BSC and PDSC patients was 19 months and 30 months, respectively. The 4-year survival rate was 22.4% and 36.1%, respectively （u=0.740, P=0.230）. No significant difference was found in survival rate between stage Ⅰ and stage Ⅱ patients （Х^2=0.109, P=0.2974）. The median survival time of stage Ⅰ and stage Ⅱ patients was 19 months and 46 months, respectively; and the 4-year survival rate of stage Ⅰ and stage Ⅱ patients was 47.3% and 45.2%, respectively （u=0.122, P=0.450）. Using Cox proportional hazard model, we found that surgical types and clinical stages of BSC were correlated with its prognosis. Compared with that of patients who received Iobectomy, the postoperative mortality hazard of patients who received pneumonectomy and segmentectomy was increased by 1.379 times （P=0.031）and 1.634 times （P=0.061）, respectively. A more advanced clinical stage was associated with an increase in the postoperative mortality hazard ratio （Х^2 = 14.12, P=0.000）. The postoperative mortality hazard of patients of stage Ⅲ and stage Ⅳ was 2.437 times higher than that of stage Ⅰ patients （P=0.018）. There were no statistical differences in postoperative mortality risk between stage Ⅰ patients and stage Ⅱ patients （P=0.057）. Conclusion： Compared with that of PDSC, the incidence of BSC is higher among females. However, there is no difference in the prognosis between BSC and PDSC. BSC can be treated with the same therapies as those for other types of non-small cell lung cancer （NSCLC）.