肺癌伴白细胞增多的诊断、机制及预后(附4例病例报告)

The diagnosis,mechanisms and prognosis of Tumor-Related Leukocytosis in Patients with Lung Carcinoma

目的提高对肿瘤伴白细胞增多综合征的认识。方法回顾分析我院4例肺癌伴白细胞增多患者的诊治过程,并复习文献中肺癌伴白细胞增多诊断、机制及对预后的影响。结果 4例均为ⅢA期肺癌患者,术前白细胞增多(平均达31.1×109/L);3例术后白细胞降至正常,1例较术前大幅下降但仍高于正常水平;4例出院后定期随访,2例随访至4个月时发现转移。结论肺癌伴白细胞增多较少见,其诊断须排除其它原因引起的白细胞增多,其发生与肿瘤释放某些细胞因子有关,是预后不良的表现。

Background and Objetive Tumor-related leucocytosis is a paraneoplastic syndrome that is encountered occasionally in the clinical course of patients with lung cancer.Our study aimed to improve the recognition of lung cancer presenting with leucocytosis.Methods Retrospectively analyze the general information,clinical features,results of biochemical and pathological examinations of 4 patients with lung cancer related leucocytosis.Results 4 patients presented with leucocytosis at intial onset,which is 31.1×109/L on average.the white blood cell count dropped to normal after the operation in 3 cases,and in 1 case,the white blood cell count declined sinificantly but still above normal,All patients were followed-up,bone and lung metastasis was found in 2 case respectively 4 months later.Conclusions The diagnosis of tumor-related leukocytosis should exclude other diseases.Autonomous prodution of hematopoietic cytokines（GSF,TNF,IL etc.） has been identified to be related with the syndrome and it is widely accepted now leucocytosis is a significant negative prognostic factor for lung cancer.