跨叶型肺腺癌临床分期及手术方式的研究

Investigation of clinical stage and surgical method of lung adenocarcinoma of trans-lobe type

目的探讨跨叶型肺腺癌最准确的T分期和最佳手术方式,为该类型肺癌的诊治提供依据。方法选取2008年1月—2013年6月于天津医科大学总医院行肺部手术的肺腺癌患者192例,根据2009年国际肺癌联合学会(IASLC)颁布的第7版TNM分期标准筛选出T2期(T2组)163例及T3期(T3组)12例作为对照,其余17例为跨叶型肺腺癌组(跨叶组)。比较3组患者临床资料和预后情况。依据跨叶型肺腺癌的影像学及病理组织学表现诊断跨叶型肺腺癌,并参考2011年肺腺癌国际多学科分类新标准对跨叶型肺腺癌进行亚型鉴定。应用Kaplan-Meier法分析跨叶型肺腺癌不同亚型及手术方式的预后情况。结果跨叶型肺腺癌患者的术后生存率与T3期相近(P>0.05),明显低于T2期(P<0.05)。跨叶组以双肺叶切除和单纯肺叶加相邻肺叶受侵部分切除为主(P<0.05),不同术式生存时间和生存率差异均无统计学意义。跨叶组17例患者中包含4种肺腺癌亚型,分布为实体状为主型腺癌8例、腺泡样为主型腺癌5例、乳头状为主型腺癌3例、浸润性黏液腺癌1例;4种亚型生存时间和生存率差异均无统计学意义。结论跨叶型肺腺癌临床分期应归为T3期;双肺叶切除和肺叶加相邻肺叶受侵部分切除均为跨叶型肺腺癌外科治疗的有效手段。

Objective To explore the most accurate T staging and optimal surgical method of lung adenocarcinoma oftrans-lobe type, and to provide supportive diagnosis as well as therapeutic evidences for this disease. Methods A total of192 postoperative patients, hospitalized in Tianjin Medical University General Hospital from January 2008 to June 2013,who were diagnosed with lung adenocarcinoma were recruited. Patients were divided into three groups according to the 7thedition of TNM staging criteria issued by the IASLC in 2009. A total of 163 patients with T2 stage were selected as GroupT2, and 12 patients with T3 stage were selected as Group T3, both of which were considered as control groups. Other 17 pa-tients who were diagnosed as trans-lobe type of lung adenocarcinoma, were Group trans-lobe. The clinical data and progno-sis were compared between three groups. The trans-lobe type of lung adenocarcinoma was diagnosed based on imaging andpathological examination. Subtypes of trans-lobe lung adenocarcinoma were identified by referring to 2011 international mul-tidisciplinary classification standard of lung adenocarcinoma. Kaplan-Meier method was used to analyze the prognosis of dif-ferent subtypes and surgical modus in patients with lung adenocarcinoma of trans-lobe type. Results By comparison, thepostoperative survival rate was significantly lower in patients diagnosed with trans-lobe type of lung adenocarcinoma thanthat of Group T2（P0.05）, and no significant difference in survival rate compared with Group T3（P0.05）. There were nosignificant differences in survival rates between different surgical modus（P0.05）. Seventeen patients with trans-lobe typeof lung adenocarcinoma consisted of four subtypes, including 8 solid predominant, 5 acinar predominant, 3 papillary predomi-nant and 1 invasive mucinous adenocarcinoma. There were no statistical significances in postoperative survival time and sur-vival rates between four subtypes. Conclusion The clinical stage of trans-lobe type of lung adenocarcinoma should be clas-sified as stage T3. Both pulmonary bilobectomy and lobectomy combined with resection of proximal invaded lobe can be usedas effective surgical therapies for trans-lobe type of lung adenocarcinoma.