特发性肺纤维化合并肺癌37例临床分析

Clinical Analysis of 37 Cases of Lung Cancer with Idiopathic Pulmonary Fibrosis

目的探讨特发性肺纤维化合并肺癌的临床特点、诊断、治疗和预后。方法回顾性分析37例特发性肺纤维化合并肺癌患者的临床症状、实验室检查、胸部影像学、病理、治疗及预后。结果 37例患者的平均年龄(70.7±1.2)岁,男女比例为34∶3,平均吸烟指数(809.5±77.5)年·支,临床症状主要为咳嗽咳痰(19/37),干咳(9/37),痰中带血或咯血(5/37),胸闷气急(18/37)。特发性肺纤维化合并肺癌的患者血清NSE、CEA、CA125水平较单纯特发性肺纤维化患者高。胸部CT表现为在肺纤维化病变明显的肺周边近胸膜区域出现了团块状或结节状的肿块,其中8例患者伴有胸腔积液(8/37)。病理类型以腺癌(14/37)及鳞癌(13/37)为主。大多数特发性肺纤维化患者发现合并肺癌时基本已处于肺癌中晚期,预后差,37例患者的中位生存期为6个月。结论特发性肺纤维化合并肺癌发生率高,易漏诊及误诊,且治疗难度大,预后差,需尽早行相关有创检查明确诊断。

Objective To study the clinical feature, diagnosis, treatment and prognosis of lung cancer with idiopathic pulmonary fibrosis （IPF-LC）. Methods Clinical symptoms,laboratory tests, chest imaging, pathology, treatment and prognosis of 37 patients with IPF-LC were analyzed retrospectively. Results Mean age and average smoking index of 37 patients were （70.7 ±1.2 ） years and （809.5 ± 77.5 ） piece/year. 34 patients were male. Clinical syndromes including cough and expectoration （ 19/ 37 ）, dry cough （9/37）, bloody sputum or hemoptysis （ 5/37 ）, and dyspnoea （ 18/37 ）. CEA, CA125 and NSE in IPF-LC were higher than those with idiopathic pulmonary fibrosis. Chest CT showed a massive or nodular mass in the area near the pleural area of the lung with obvious lung fibrosis. In addition, there were 8 patients with pleural effusion. The pathological types were adeno- carcinoma （14/37） and squamous cell carcinoma （13/37）. Most of the patients were in the advanced stage of lung cancer when they were diagnosed. The prognosis was poor and the median survival was only 6 months. Conclusion IPF-LC has high inci- dence, which is easily miss diagnosed or misdiagnosed, and the treatment is difficult with poor prognosis. The invasive examination should be taken as early as possible.