原发性中央型和周围型肺鳞癌临床病理学及预后差异

Clinicopathological factors and prognosis between primary central and peripheral lung squamous cell carcinoma

目的回顾性分析原发性肺鳞癌患者临床病理特征及预后,为肺鳞癌诊治提供临床依据。方法选择2009年1月至2013年12月收治的447例原发性肺鳞癌患者,其中中央型173例,周围型274例。针对不同变量类型分别采用t检验、χ~2检验、非参数秩和检验比较各变量是否有统计学差异,采用Mantel-Haenszel χ~2检验确定两个有序分类变量之间是否存在线性趋势。采用Kaplan-Meier法绘制生存曲线,以Log-rank法比较不同生存曲线的差异。结果原发性中央型和周围型肺鳞癌患者在男女构成比、年龄、病理特征、手术方式、不同肿瘤直径及分化程度的淋巴结转移状况、不同淋巴结转移分期间预后等方面的差异具有统计学意义(P均<0.05)。原发性中央型肺鳞癌1、3、5年生存率分别为92.70%、53.60%、33.76%,原发性周围型肺鳞癌分别为97.11%、70.72%、40.81%,二者预后差异具有统计学意义(χ~2=9.561,P<0.001)。结论原发性中央型和周围型肺鳞癌患者在男女构成比上的差异具有统计学意义。原发性中央型肺鳞癌较周围型易于发生淋巴结转移,预后更差,且发病年龄较周围型有年轻化趋势。肿瘤分化程度及大小与淋巴结转移关系密切,低分化、肿瘤直径≥3 cm淋巴结转移率增高。

Objective To study the clinicopathological features and the prognosis of primary lung squamous cell carcinoma retrospectively and to provide effective methods for diagnosis and treatment.Methods A retrospective study of the clinical data of 447 primary lung cancer patients from January 2009 to December 2012 was made,including 173 cases of central squamous carcinoma and 274 cases of peripheral lung squamous carcinoma.Student＇s t test,Pearson chisquare test,and parametric test of rank transformation were conducted to identify whether there is a significant difference in the clinicopathological factors between central or peripheral lung squamous cell carcinoma.The survival curve was drawn by Kaplan-Meier method,while different survival curves were compared by Log-rank method.Results The difference of sex,age,pathological features,surgical methods,lymph node metastasis of different tumor diameter and differentiated degree,prognosis of lymph node metastases staging were statistically significant.The 1,3 and 5 year survival rate of central squamous carcinomas was 92.70%,53.60% and 33.76% respectively,and that of peripheral squamous carcinoma was 97.11%,70.72% and 40.81%.The prognosis between central and peripheral lung squamous cell carcinoma was significantly different（χ~2=9.561,P〈0.001）.Conclusion The constituent ratio between the male and the female showed statistical difference in peripheral and central lung squamous cell carcinoma.Compared with peripheral lung squamous cell carcinoma,central type had a higher rate of lymph node metastasis,poorer prognosis and youth oriented tendency.In addition,it revealed that the rate of lymph node metastasis was positively related with an increasing size and poorer differentiation of the tumor.