31例原发性肺类癌的诊治及预后分析

Diagnosis,treatment,and prognostic analysis of thirty-one cases with primary bronchopulmonary carcinoid

目的:探讨原发性肺类癌的临床病理特征、CT表现、治疗方法及预后。方法:回顾性分析31例原发性肺类癌患者的诊治过程,并对预后行单因素和多因素分析。结果:临床表现:咳嗽、咳痰17例,咯血或痰中带血7例,胸痛、胸闷气短8例,无症状6例。CT表现:圆形或类圆形结节影,界限多清楚,增强可见轻度均匀强化。免疫组织化学检测提示:Syn、CgA、NSE阳性表达率分别为90.3%(28/31)、87.1%(27/31)、90.3%(28/31)。治疗及预后:28例行手术治疗(3例行术后辅助治疗);2例行化疗,1例拒绝治疗。典型和不典型类癌的总体1年生存率分别为100%(18/18)、92.3%(12/13),3年生存率为94.4%(17/18)、69.2%(9/13)。单因素分析示淋巴结转移(P=0.02)、组织类型(P=0.017)、TNM分期(P=0.005)和治疗方法是影响预后的因素(P=0.01)。多因素分析示淋巴结转移(P=0.032)、组织类型(P=0.002)是影响预后的因素。结论:原发性肺类癌的临床及影像表现缺乏特异性,其诊断主要依靠组织病理。手术是其主要且有效的治疗途径,放化疗效果不佳;总体预后较好,但不典型类癌次于典型类癌,病理类型和淋巴结转移情况是影响预后的重要因素。

Objective：We aimed to explore the clinical features, computed tomography （CT） findings, treatment, and prognosis of bronchopulmonary carcinoid. Methods：Clinical data of 31 patients with primary carcinoid tumor of the lung were retrospectively reviewed. The prognostic factors were analyzed via Cox univariate and multivariate analyses. Results： Clinical symptoms included coughing or expectoration in 17 of the 31 cases, hemoptysis or blood-stained sputum in 7 cases, and chest pains or shortness of breath in 8 cases. Six cases were asymptomatic. The CT scans showed round or oval nodules with clear boundaries, and enhancement CT scans indicated mild, homogeneous enhancement. Immunohistochemistry results revealed the positive expression rates of synaptophysin （Syn）, chromogranin A （CgA）, and neuron-specific enolase （NSE） were 90.3%（28/31）, 87.1%（27/31）, and 90.3%（28/31）, respectively. Therapy and prognosis results were as follows：28 of the total number of patients underwent surgery, among which 3 underwent postoperative adjuvant therapy, 2 received chemotherapy; and only 1 refused treatment. The 1-year overall survival rates were 100%（18/18） and 92.3%（12/13）, whereas the 3-year survival rates were 94.4%（17/18） and 69.2%（9/13） in the typical and atypical carcinoid cases, respectively. Cox univariate analysis results revealed that lymphatic metastasis （P=0.02）, tissue types （P=0.017）, TNM stage （P=0.005）, and therapies （P=0.01） were the prognostic factors. Cox multivariate analysis results showed that lymphatic metastasis （P=0.032） and tissue types （P=0.002） were the independent prognostic factors. Conclusion：Compared with other lung cancers, the bron-chopulmonary lung carcinoid has no special clinical manifestation in clinical and radiographic images. The diagnosis was mainly based on histopathology results. Surgery was the main and effective treatment, whereas chemotherapy and radiotherapy showed unsatisfactory results. The overall prognosis was satisfactory. However, the atypical carcinoid was inferior to the typical carcinoid in terms of prognosis. Pathological typing and lymph node metastasis were significant prognostic factors.