原发性周围型微小肺癌临床特征及预后分析

Clinical features and prognosis of primary peripheral lung carcinoma with micro-size

目的了解≤1.0cm原发性周围型微小肺癌的临床特征及其预后情况。方法采用回顾性研究方法对≤1.0cm微小肺癌的临床特征、CT征象及其预后情况进行分析。结果 193例微小肺癌中190例(98.5%)为肺腺癌,微小肺腺癌以女性、≤60岁患者为主,术前外周血清癌胚抗原(CEA)水平多在正常范围内,病理学类型多表现为原位腺癌或微浸润腺癌,CT征象多表现为纯磨玻璃结节或混合磨玻璃结节,均无淋巴结转移且临床分期为0期或Ⅰ期。不同大小0.5~0.7(0.6±0.07)cm和>0.7~1.0(0.9±0.09)cm的微小肺腺癌患者在性别、年龄、吸烟状态、术前血清CEA水平、肿瘤是否侵犯肺膜、有无淋巴结转移、临床分期、手术方式、病理类型和CT征象等方面比较,差异均无统计学意义(均P>0.05)。不同病理学类型的微小肺腺癌患者在性别、吸烟状态、CEA水平、临床病理分期、CT征象方面比较,差异均有统计学意义(均P<0.05)。对微小肺癌患者随访14~96个月后,所有患者手术后预后均较好,无死亡病例,总生存率为100.0%。结论微小肺癌以腺癌为主,均无淋巴结转移发生,预后较好。对于CT征象表现为纯磨玻璃结节,术前外周血清CEA正常的微小肺癌患者可采取楔形切除或肺段切除的手术方式。

Objective To investigate the clinical characteristics and prognosis of patients with peripheral micro-size lung carcinoma.Methods The clinical features,imaging findings and prognosis of193patients with primary peripheral lung carcinoma,whose cancer size was≤1cm in diameter,were retrospectively analyzed.Results Among193patients there were139females and54males with a mean age of53.5±10.3years(22-79).Most of patients had low preoperative peripheral CEAl evels(<5.0IU/ml).Adenocarcinoma was the dominant pathological type(190/193,98.5%),and the main subtypes were adenocarcinoma in situ(AIS)and micro-infiltrating adenocarcinoma(MIA).The CT findings were pure ground glass opacity(pGGO)and mixed ground glass opacity(mGGO).All patients had no lymph node metastasis with a pathological stage0or stageⅠ.There were significant differences in gender,smoking status,CEA levels,pathological stages and CT findings among differenttypes of micro-sized lung adenocarcinoma(AIS,MIA,IAC)(all P<0.05),whereas no significant difference between patients withtumor size0.5-0.7cm and those0.7-1.0cm(all P>0.05).After14-96months follow-up,all patients were alive after surgery.Conclusion The main subtype of micro-sized lung cancer was adenocarcinoma,with no lymph node metastasis and favorable prognosis.Wedge resection and segmentectomy are recommended for those patients with pGGO and normal preoperative CEA level.