支气管肺类癌临床和病理学特点的回顾性研究

Retrospective Study of Clinicopathological Characteristics in Bronchopulmonary Carcinoid

背景与目的支气管肺类癌(bronchopulmonary carcinoid,BPC)占全部肺原发性恶性肿瘤不到2%,相关研究报道较少,本研究拟分析BPC的总体及其两个亚型——典型类癌(typical carcinoid,TC)和不典型类癌(atypi-cal carcinoid,AC)的临床、病理学特点。方法回顾性分析中山大学肿瘤防治中心1994年1月-2009年6月收治的28例BPC的临床资料,调取可再行切片的病理蜡块,重新切片染色及病理玻片会诊,分析BPC的总体及其亚型的临床特征和相关免疫组化指标与预后的关系。结果全部28例患者的总体5年生存率为56%,TC的5年生存率为70%,AC为41%,单因素分析示TNM分期(P=0.037)、有无淋巴结转移(P=0.001)、Ki-67核阳性数是否大于5%(P=0.009)是BPC总体的预后因素。相关性分析示BPC亚型与CD99、Bcl-2及Ki-67的表达具有相关性(P值分别0.017、0.043、0.033)。20例行肺癌根治性手术患者的5年生存率为73%,TC的5年生存率为83%,AC为57%。单因素分析示BPC亚型(P=0.013)、术后有无淋巴结转移(P=0.004)、Ki-67核阳性数是否大于5%(P=0.006)、TNM分期(P=0.047)是行肺癌根治性手术患者的预后因素。肿瘤复发(n=4)与Ki-67核阳性的表达和Bcl-2表达具有相关性(P值分别为0.027、0.045)。结论BPC是预后较好的肺原发性恶性肿瘤,Ki-67、Bcl-2的高表达是提示BPC复发及预后不良的影响因素,TNM分期是影响预后的独立因素,行根治性手术是主要的治疗手段。

Background and objective Bronchopulmonary carcinoid （BPC） account for less than 2% of all primary lung malignant tumors, but few related studies were reported. The aim of this study is to analyze this rare disease＇s clinicopathological characteristics. Methods the clinical data of 28 patients with BPC in Cancer Center of Sun Yat-sen University, from January 1994 to June 2009, were enrolled into retrospective analysis. First, the corresponding paraffin blocks reexamined, slice up and stained, multiple pathologists re-consulted, and its subsets （typical carcinoid, TC; atypical carcinoid, AC） defined. Second, the clinical characteristics and immunohistochemical markers and its relationship with prognosis were analyzed. Results First, the 5-year survival for overall and TC, AC was 56% and 70%, 41% respectively in 28 cases. The markers CD99, Bcl-2 and Ki-67 expression correlated significantly with the BPC subsets （P=0.017, P=0.043, and P=0.033 respectively）. Further univariate analysis revealed that advanced TNM staging （P=0.037）, lymph node metastasis （P=0.001） and Ki-67 nucleolus＇s positive expression （P=0.009） are poor prognostic factors. Second, the overall, TC, AC 5-year survival rate was 73%, 83%, 57% respectively in 20 cases underwent the radically surgical resection. Further univariate analysis revealed that AC subset （P=0.013）, lymph node metastasis （P=0.004） and Ki-67 nucleolus＇s positive expression （P=0.006）, advanced TNM staging （P=0.047） are poor prognostic factors in this 20 cases. Third, as univariate analysis, local recurrence and metastasis （n=4） correlate significantly with Ki-67 nucleolus＇s and Bd-2 positive expression （P=0.027, 0.045, respectively）. Conclusion The prognosis of BPC was better than other types of prirnary lung cancer. Ki-67, Bcl-2 high expression and advanced TNM staging are the poor recurrence and prognostic factors of BPC. The radical surgery remains the treatment of choice for resectable candidates in BPC NSCLC.