肺粘液表皮样癌的临床特征及预后影响因素分析

Analysis of the clinical features and prognostic factors of pulm-onary mucinous carcinoma

目的探讨肺黏液表皮样癌的临床特征、诊治及预后因素，提高该病的诊治水平。方法搜集近5年南京军区福州总医院确诊的肺粘液表皮样癌9例及知网搜集近10年的292例病例，分高级别组和低级别组，回顾性分析这301例的临床资料，并对其预后影响因素进行分析。结果行手术治疗198例，术后放化疗34例，综合性放化疗56例，靶向药治疗6例，41例放弃治疗，5年生存率43．6％。淋巴结转移情况及肿瘤分期两组比较，差异有统计学意义（P均〈0．0001）。进行Log-rank检验分析显示，年龄、病理分类、淋巴结转移、分期均会影响生存期，而在多因素COX回归分析中显示，淋巴结转移对生存期下降是独立的危险因素（HR：0．358；95％CI：0．114～0．265；P〈0．0001）。结论肺粘液表皮样癌是罕见肿瘤，其预后受多因素影响，而淋巴结转移是最重要的影响因素。目前手术治疗仍是唯一有效手段，且放化疗的疗效尚缺乏统一定论，靶向治疗是极具潜力的治疗方法。

Objective The aim of the present study was to explore the clinical features of Pulmonary mueoepidermoid carcinoma （PMEC） and to analysis the tumor＇s treatment and prognosis factors, to improve the awareness of the disease and the level of diagnosis and treatments. Methods To collect nearly 5 years of Fuzhou general hospital of Nanjing military region which were diagnosed with PMEC underwent 9 cases and the last decade of 292 literature cases collected from CNKI. The patients were classified into lowgrade group and high-grade group, based on histological grades. The clinical data, radiological manifestation, pathological findings, treatment strategy, and prognoses of all patients were analyzed retrospectively. Results Surgical treatment were 198 cases, 34 cases from these cases accepted postoperative radiation or chemotherapy, Comprehensive radiation and chemotherapy included 56 cases, 6 patients by targeting therapy, and 41 cases give up treatment; the 5 year survival rate was 43.6%. High-grade PMEC often with high malignant, and was more common in patient with advanced tumor-node-metastasis （TNM） stage and lymph node metastasis respectively（all P〈0.000 1）. Log-rank test analysis showed that age, pathological grade, lymph node metastasis and TNM stage were correlated with the survival of PMEC patients. In the forward conditional Cox regression model, lymph node metastasis was the most important influencing factors （HR, 0.358, 95%CI, 0.114 - 0.265, P〈0.000 1）. Conclusions Lung mucous epidermoid carcinoma is a rare tumor, prognosis is influenced by many factors, and lymph node metastasis is one of the most important influencing factors. The surgical treatment is still the only effective means at present. And the curative effect of radiation and chemotherapy and there is no unified conclusion, targeted therapy is a promising treatment.