不同组织学分型肺腺癌患者的临床特征及预后影响因素研究

Clinical Features of Lung Adenocarcinoma Patients of Different Histological Types and Influencing Factors for Prognosis

目的：回顾性分析原位腺癌（AIS）、微浸润性腺癌（MIA）、浸润性腺癌的临床病理特征及预后的影响因素，为早期肺腺癌的明确诊断及临床治疗提供依据。方法回顾性选取2008年11月—2012年11月于河北医科大学第四医院行手术治疗的Ⅰ期肺腺癌患者190例为研究对象，其中 AIS 7例，MIA 71例，浸润性腺癌112例。收集患者临床特征资料，自病理诊断为起点进行随访，随访截至2015年4月，结局事件为死亡。采用 xTAG 液相芯片法检测EGFR 基因18～21号外显子的基因突变。结果 AIS、MIA、浸润性腺癌患者性别、TNM 分期、肿瘤直径及发病部位比较，差异均有统计学意义（P ＜0.05）。AIS/ MIA 患者5年生存率为100.0％，浸润性腺癌患者5年生存率为82.7％，差异有统计学意义（χ^2＝13.591，P ＜0.001）。Cox 比例风险回归模型分析显示，吸烟〔HR ＝0.084，95％ CI（0.018，0.391）〕、TNM 分期〔 HR ＝2.528，95％ CI（1.081，5.911）〕及 EGFR 基因突变〔 HR ＝3.025，95％ CI（1.279，7.157）〕是肺腺癌患者预后的影响因素（P ＜0.05）。结论 AIS、MIA 患者预后较好，吸烟、TNM 分期及 EGFR 基因突变是肺腺癌患者预后的影响因素，国际新分类系统有助于肺腺癌患者预后评估。

Objective Retrospective analysis of clinical features of lung adenocarcinoma patients of different histological types and influencing factors,in order to provide references for the definite diagnosis and clinical treatment of early lung adenocarcinoma. Methods A total of 190 patients with stage Ⅰ lung adenocarcinoma who received operative treatment in the Fourth Hospital of Hebei Medical University from November 2008 to November 2012 were enrolled as subjects. Among them, 7 patients had AIS,71 patients had MIA and 112 patients had infiltrating adenocarcinoma. The clinical data of the subjects were collected;pathological diagnosis was taken as the starting point and April 2015 was taken as the end point;death was taken as the outcome event. xTAG liquidchip technology was used to detect the gene mutation of exon 18 - 21 of EGFR gene. Results The three types of patients were significantly different in gender,TNM staging,diameter of tumor and pathogenic site（ P 〈0. 05）. The 5 - year survival rate of AIS/ MIA patients was 100. 0% ,and that of infiltrating adenocarcinoma patients was 82. 7% ;significant difference existed among them（ χ^2 = 13. 591,P 〈 0. 001）. Cox proportional hazards regression model analysis showed that,smoking〔 HR = 0. 084,95% CI（0. 018,0. 391）〕,TNM staging〔 HR = 2. 528,95% CI（1. 081, 5. 911）〕and EGFR gene mutation〔HR = 3. 025,95% CI（1. 279,7. 157）〕were influencing factors for the prognosis of lung adenocarcinoma patients（P 〈 0. 05）. Conclusion Patients with AIS,MIA have good prognosis. Smoking,TNM staging and EGFR gene mutation are influencing factors for the prognosis of lung adenocarcinoma patients. New international classification system is helpful for the prognosis evaluation of lung adenocarcinoma patients.