肺结核并发肺癌患者的临床特点和生存状况研究

Clinical features and survival status of patients with pulmonary tuberculosis with concurrent lung cancer

目的 观察肺结核并发肺癌患者的临床特点和生存状况,探讨影响预后的相关因素。方法 回顾性分析2004年1月-2009年12月该院收治的80例肺结核并发肺癌患者的临床和影像学特征。采用Kaplan-Meier法计算各亚组1、3及5年生存率,并用Log-rank检验进行比较。采用多因素Cox比例风险回归模型进行预后分析。结果 咳嗽（45.0%）是最常见的首发症状。32例（40.0%）患者的肿瘤位于左肺,39例（48.8）患者的肿瘤位于右肺,9例（11.3%）患者的肿瘤位于双肺。周围性肺癌的发生率为65.0%。最常见的病理类型是鳞癌（57.5%）。肿瘤TNM分期方面,Ⅰ、Ⅱ、Ⅲ及Ⅳ期分别占61.3%、38.8%、27.5%和11.3%。结节状团块是最常见的影像学表现,占41.3%。患者中位生存时间为27个月,1、3及5年总生存率分别为66.7%、46.8%和31.1%。肺结核处于活动期、肿瘤TNM分期为Ⅲ-Ⅳ期、结核与肿瘤病灶不是同一病灶是导致肺结核并发肺癌预后不良的独立危险因素（〈0.05）。结论 肺结核并发肺癌患者无特异性的临床症状,影像学检查,特别是胸部HRCT有助于早期诊断,肺结核是否活动、肿瘤TNM分期、结核与肿瘤病灶是否为同一病灶是影响患者预后的独立因素。

[ Objective ] To observe the clinical features and survival status of patients with pulmonary tuberculosis with concurrent lung cancer, then investigate the related factors affecting the prognosis. [Methods] Clinical and imaging features of 80 patients with pulmonary tuberculosis with concurrent lung cancer from January 2004 to December 2009 were retrospectively analyzed. Kaplan-Meier method was used to calculate 1-year, 3-year and 5-year survival rate of each sub-group, and Log-rank test was performed to compare. Multivariate Cox proportional hazard regression model were used to prognosis analysis. [Results] The most common first symptom was cough （45.0%）. The tumors of 32 cases （40.0%） were in the right lung, 39 cases （48.8%） were in left lung and 9 cases （11.3%） were in bilateral lung. The rate of peripheral lung cancer was 65.0%. The most common pathological type was squamous cell carcinoma （57.5%）. The rate of period Ⅰ , Ⅱ, Ⅲ, Ⅳwere respectively 61.3%, 38.8%, 27.5%, 11.3%. Nodular masses （41.3%） was the most common manifestation of imaging. The median survival time was 27 months, and 1- year, 3-year and 5-year survival rate were 66.7%, 46.8%, 31.1%. Active pulmonary tuberculosis, period Ⅲ-Ⅳand different lesion were independent risk factors of poor prognosis in patients with pulmonary tuberculosis with concurrent lung cancer （P 〈 0.05）. [ Conclusion ] The clinical symptoms of patients with pulmonary tuberculosis with concurrent lung cancer are not specific. Imaging examination, especially the chest HRCT is helpful to early diagnosis of pulmonary tuberculosis. Activity of tuberculosis, TNM stage of tumor, the relation of lesions of tuberculosis and cancer were independent factors affecting the prognosis.