79例肺肉瘤样癌的临床特征及预后分析

Clinical Features and Prognosis of 79 Cases of Pulmonary Sarcomatoid Carcinoma

目的通过分析肺肉瘤样癌(pulmonary sarcomatoid carcinoma,PSC)的临床资料,探讨其临床特征及预后因素。方法回顾性分析79例PSC患者的临床资料,采用SPSS19.0统计软件对患者的性别、年龄、是否有吸烟史、肿瘤的原发部位、位置类型、肿瘤大小、T分期、有无淋巴结转移、有无远处转移、TNM分期、组织学亚型、治疗方法及是否手术等因素进行预后分析。采用Kaplan-Meier法进行生存分析,采用Log rank法进行单因素分析,采用Cox比例风险回归模型进行多因素分析。结果与腺癌、鳞癌、小细胞癌等肺癌亚型相似,PSC患者多以咳嗽、胸闷、发热、痰中带血、咯血、胸痛等为初诊症状。本研究中患者的1、2、3年总生存率分别为25.3%、8.0%、4.8%,中位生存时间为8.0月。单因素分析显示,年龄、肿瘤大小、T分期、有无远处转移、TNM分期、治疗方法及是否手术是影响预后的因素。结论 PSC是一类少见的、侵袭性较高的非小细胞肺癌,预后差。与其他肺部肿瘤相比,PSC缺乏典型的临床表现,诊断主要依靠病理学和免疫组织化学方法。本研究中患者的年龄、肿瘤大小和治疗方法是影响预后的独立因素,手术联合放化疗是首选治疗方法。

Objective To analyse the clinical data of pulmonary sarcomatoid carcinoma（PSC） and investigate the clinical features and prognostic factors. Methods The clinical data of 79 cases of pulmonary sarcomatoid carcinoma were analyzed retrospectively. The correlation between prognosis and gender, age, smoking history, primary tumor site, tumor size, location type, T staging, lymph node metastasis, distant metastasis, TNM staging, histological subtype, therapeutic method, surgery or not were analyzed by statistical software SPSS 19.0. Kaplan-Meier method was used for survival analysis. Log-rank test was used for univariate analysis, and Cox proportional hazard regression model was used to carry out multivariate analysis. Results PSC patients mainly presented with the symptoms of cough, chest tightness, fever, bloody sputum, hemoptysis, chest pain, which were similar to other types of lung cancer, such as adenocarcinoma, squamous cell carcinoma and small cell carcinoma. The overall 1-, 2-, 3-year survival rates were 25.3%, 8.0%, 4.8%, respectively. The median survival time was 8.0 months. Univariate analysis showed that age, tumor size, T stage, distant metastasis, TNM staging, treatment and surgery or not were prognostic factors. Conclusion PSC is a rare, aggressive, poorly-differentiated non-small cell lung cancer, with poor prognosis. Compared with other lung tumors, PSC lacks typical clinical manifestations. The diagnosis mainly depends on pathology and immunohistochemistry. Age, tumor size and therapeutic method are independent prognostic factors. Surgical resection combined with postoperative chemoradiotherapy is the preferred therapeutic method.