2056例手术切除肺腺癌的临床病理分析

Clinicopathologic study based on 2 056 cases of pulmonary resection of lung adenocarcinoma

目的 探讨肺腺癌IASLC/ATS/ERS国际多学科分类中各组织学亚型的临床病理特征,旨在进一步认识肺腺癌新分类其临床病理特征在临床诊疗中的应用价值.方法 收集上海交通大学附属上海胸科医院2012年6月至2013年5月手术切除的2 056例原发性肺腺癌病例资料,根据新分类进行分型并分析其临床病理特征.结果 肺腺癌女性高发;平均年龄59岁,女性发病年龄低于男性（58.7岁对60.2岁,P＜0.01）;肿瘤平均直径2.6 cm;发生部位右肺多于左肺,上叶多于下叶;组织学亚型以腺泡为主型和乳头为主型浸润性腺癌多见;微乳头为主型和实性为主型浸润性腺癌更易发生胸膜侵犯和淋巴结转移;Ⅰ期患者占71.7％,其中Ⅰa期患者占53.1％.结论 肺腺癌IASLC/ATS/ERS国际多学科分类可以更好地反映肺腺癌的临床病理特征,有利于促进早期肺腺癌外科手术策略的改变及更新.

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients （58.7 years vs 60.2 years,P ＜ 0.01） ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ（71.7％）,which were predominantly stage Ⅰa （53.1％）.Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.