721例非小细胞肺癌临床病理学特征分析

Analysis of the clinicopathological features of 721 cases with NSCLC

目的:研究非小细胞肺癌(non-small cell lung cancer,NSCLC)患者临床特征、影像学征象、支气管镜下表现与病理类型的关系。方法:收集2009年1月至2014年12月我院721例NSCLC患者的临床资料。利用SPSS 13.0统计软件进行分析。结果:在721例NSCLC患者中,男女比例为3.65∶1。鳞癌是最常见病理类型(57.00%),男性患者中鳞癌比例最高,女性患者中腺癌比例最高(P<0.01)。平均发病年龄为(59.72±0.54)岁;40岁以下患者占比低(3.61%),其中腺癌比例明显高于鳞癌。非吸烟患者中腺癌比例最高(68.45%);吸烟者中鳞癌比例最高(65.92%),特别是吸烟指数大于400的患者鳞癌比例更高。临床症状以咳嗽、咳痰、咯血或痰中带血、胸闷气短最为常见,无明显症状体征少(5.13%)。肺部肿块影(66.30%)仍是NSCLC的主要影像学征象。NSCLC在支气管镜下多表现为外向型生长(47.43%)。NSCLC支气管镜及影像学特点相结合,支气管镜下鳞癌的外向型生长明显高于腺癌。在影像学特征中,腺癌肿块影、阻塞性肺炎、胸腔积液、毛刺征/分叶征出现率明显高于鳞癌。结论:NSCLC在中老年患者中高发,对于有咳嗽、咳痰、咯血或痰中带血、胸闷气短等症状及吸烟患者尤应引起重视。常规检查仍推荐影像学(胸部CT等)及支气管镜进行筛选。仔细分析患者症状及影像学结果,进行有针对性的检查和病理活检,可能使患者诊断时间缩短,得到及时治疗。

Objective： To describe the clinical characteristics,chest CT,electronic bronchoscope findings and different pathological types in patients of NSCLC. Methods： A retrospective study was analyzed in clinical data of 721 patients of NSCLC in our hospital. Data were analyzed using SPSS v13. 0. Results： The ratio of male and female was 3. 65∶ 1. Men were found to be more likely to have squamous cell carcinoma. Women were found to be more likely to have adenocarcinoma（ P〈0. 01）. The average age was（ 59. 72 ± 0. 54） years old. NSCLC patients under 40 years old accounted for 3. 61%,and the percentage of adenocarcinoma was significantly higher than squamous cell carcinoma（ P〈0. 05）. Squamous cell carcinoma was the most common type in NSCLC（ 57. 00%）. Adenocarcinoma was principal type in non- smoker（ 68. 45%）,and squamous cell carcinoma was principal type in smoker（ 65. 92%）,especially for patients in the smoking index 400. The most common symptoms of NSCLC were cough,expectoration,hemoptysis or sputum with blood,chest tightness,shortness of breath,and 5. 13% of patients were asymptomatic. Mass lesions（ 66. 30%） is still the main imaging features of NSCLC. In our study,the growth of the external type（ 47. 43%） in bronchoscopy is still the main feature of NSCLC. According to the characteristics of the imaging and electronic bronchoscope findings,we found that the external type in squamous cell carcinoma was significantly higher than that of adenocarcinoma in the performance of bronchoscopy. In the imaging characteristics,the appearance rate of the masses,blocking pneumonia,pleural effusion,spiculation / lobulation in adenocarcinoma were obviously higher than that of squamous cell carcinoma. Conclusion： The diagnosis of NSCLC is usually in middle and old adulthood. A high index of suspicion is required for cough,expectoration,hemoptysis or sputum with blood,chest tightness,shortness of breath and smoking patients. Routine examination is still recommended as imaging（ chest CT,etc.） and bronchoscopy. Careful analysis of patient＇s symptoms and imaging findings in clinical practice,the targeted examination and pathological biopsy,may make the diagnosis time of patients shorten,and get timely treatment.