直径小于等于3cm的肺腺癌临床病理特点分析及临床实践

Pulmonary adenocarcinoma ≤ 3 cm in size: a clinicopathological study

目的 探讨直径≤3 cm的肺腺癌的临床病理学特点。方法 收集整理北京协和医院收治的直径≤3 cm手术切除的肺腺癌标本202例,按照2011年国际多学科分类和2015年WHO肺肿瘤组织学分类对其组织学形态进行评估。结果 202例肿瘤最大径≤3 cm的肺腺癌患者中,女性130例,男性72例,年龄33~81岁,平均年龄59.9岁。组织学观察发现：满足原位腺癌诊断的17例（8.4%）,微小侵袭性腺癌为10例（5.0%）,该两组女性患者较多（19/27,70.4%）,大部分患者均无吸烟史（22/27,81.5%）,肿瘤体积偏小,几乎所有病例中均未见胸膜侵犯、支气管侵犯及淋巴结转移。最大直径≤3 cm的侵袭性肺腺癌175例（86.6%）,其中非黏液贴壁生长为主型53例（26.2%）,与原位腺癌及微小侵袭性腺癌不同,非黏液贴壁生长为主型的少数患者存在胸膜侵犯和/或支气管侵犯及淋巴结转移;另侵袭性肺腺癌的其他亚型122例（60.4%）,包括腺泡为主型、乳头为主型、实性为主型、微乳头为主型。这些亚型通常肿瘤体积较大,胸膜侵犯和/或支气管侵犯以及淋巴结转移率明显高于非黏液贴壁生长为主型,其总体预后较后者差。结论 对202例肿瘤最大直径≤3 cm的肺腺癌,按照最新分类标准分析讨论了原位腺癌、微小侵袭性腺癌、侵袭性腺癌,非黏液贴壁生长为主型以及侵袭性腺癌的其他亚型的临床病理特征,有助于病理医生及外科医生更好的认识及理解其特点。

Objective To study the clinicopathologic characteristics of lung adenocarcinomas ≤ 3 cm in size. Methods Among 202 cases of lung adenocarcinomas ≤3 cm in size, the clinical and histological features were studied according to the 2011 IASLC/ATS/ERS classification and 2015 WHO lung tumor histological classification in Pekin Union Medical College Hospital. Results All the 202 cases were resected pulmonary adenocarcinomas. The age of patients ranged from 33 to 81 years （ mean= 59.9）, 130 cases（ 64.4% ） were female, and 72 cases（ 35.6% ） were male. Histologically, tumors were classified according to the IASLC/ ATS/ERS classification： 17 （8.4%） were adenocarcinoma in situ （ AIS ）, 10 （5.0%） minimallyinvasive adenocarcinoma （MIA）. They were observed frequently among female （ 19/27, 70.4%）, never smokers （ 22/ 27, 81.5%） and smaller tumor size. In almost all cases, no pleural invasion, bronchial invasion and lymph node metastasis were found. Besides, 175 （ 86.6% ） were invasive adenocarcinoma ≤ 3 cm in size. Among these, 53（ 26. 2%） were lepidic predominant subtype. Compared to AIS and MIA, the minor cases of lepidic predominant subtype had pleural invasion, bronchial invasion and/or lymph node metastasis. The remaining tumors （ 60. 4%） were identified as follows： 81 acinarpredominant （ 40. 1%） , 24 papillary predominant （11.2%）, 8 micropapillary predominant （4%）, 3 solid predominant （1.5%）, 6 invasive mucinous （3%）. These subtypes usually have a larger tumor size, pleural invasion and / or bronchial invasion, and lymph node metastasis rates are higher than lepidic predominant subtype, the overall prognosis was worse than the latter. Conclusions In this study, 202 cases of lung adenocarcinoma ≤ 3 cm in size were collected and analyzed. According to the IASLC/ATS/ERSclassification, the clinical and histological features of adenocarcinoma in situ, minimallyinvasive adenocarcinoma and invasive adenocarcinoma were discussed. It can help pathologists and surgeons a better understanding of lung adenocarcinoma ≤ 3 cm in size characteristics.