64例原发性肺低度恶性神经内分泌肿瘤的临床特征和预后分析

Clinical Characteristics and Prognostic Analysis of 64 Cases of Low Grade Pulmonary Neuroendocrine Tumor

目的回顾性分析在我院治疗的低度恶性肺神经内分泌肿瘤患者的临床特点和预后情况。方法收集并分析山东省肿瘤医院2009年1月至2015年12月病例资料完整的患者64例,其中典型类癌14例,不典型类癌50例。结果 64例患者就诊时中位年龄:典型类癌为55(37～68)岁,不典型类癌为62(40～78)岁。临床表现以咳嗽、胸痛、痰中带血为主。免疫组织化学检测提示:Syn、Cg A、TIF-1阳性表达率分别为87.5%(56/64)、78.1%(50/64)、75.0%(48/64)。典型和不典型类癌的总体1年生存率分别为100%(14/14)、80%(40/50),3年生存率为85.7%(12/14)、22%(11/50)。肿瘤的位置、性别、患者吸烟史与预后无关,预后相关的因素为临床分期(P <0.05)。结论低度恶性肺神经内分泌癌的临床表现缺乏特异性改变,组织病理诊断为金标准。早期可手术的患者治疗效果好,中晚期预后不佳,预后与临床分期相关。

Objective To study the clinical features and prognosis of low grade pulmonary neuroendocrine tumor.Methods 64 patients with low grade pulmonary neuroendocrine tumor,treated at Shandong Tumor Hospital from January 2009 to December 2015 including 50 subjects with typical carcinoid(TC)and 14 with atypical carcinoid(AC),were retrospectively reviewed.Results The median age of patients was 55(37-68)years for TC,62(40-78)for AC.Main clinical symptoms included coughing,thoracodynia,bloody sputum.Immunohistochemistry results revealed the positive expression rates of synaptophysin(Syn),chromogranin A(CgA),and thyroid transcription factor-1(TTF-1)were87.5%(56/64)、78.1%(50/64)、75.0%(48/64),respectively.The 1-year overall survival rates were 100%(14/14)and 80%(40/50),whereas the 3-year survival rates were 85.7%(12/14)and 22%(11/50)in the typical and atypical carcinoid cases,respectively.Location of the cancer,gender,smoking history were not relevant with prognosis,TNM stage(P<0.05)was the significant prognostic factor.Conclusion Compared with other type of lung cancers,low grade pulmonary neuroendocrine tumor has no special clinical manifestation.The diagnosis was mainly based on histopathology results.Surgery was the effective treatment for early disease,whereas metastatic disease showed unsatisfactory results.TNM stage was significant prognostic factor.