肺肝样腺癌临床病理学特点和诊治分析

Systematic analysis of clinical characteristics and diagnosis and treatment in hepatoid adenocarcinoma of the lung

目的对肺肝样腺癌的临床特点、诊治方法和预后进行分析和总结。方法检索1981—2019年中国医院知识总库(CHKD)、万方医学网、PubMed数据库中有关肺肝样腺癌的文献,并进行描述性统计分析。结果检索到相关文献54篇,共计病例61例。资料显示:肺肝样腺癌多发生于吸烟的中老年男性;临床表现主要有咳嗽、咳痰、痰中带血、气促、胸闷、胸痛等;胸部螺旋CT扫描示肿瘤多位于肺上叶;多数病例免疫组织化学染色甲胎蛋白(AFP)、肝细胞抗原表达阳性。治疗方法包括手术、放射治疗、化学治疗、分子靶向药物治疗及免疫治疗。存活病例的平均生存时间为39个月,死亡病例的平均生存时间为12个月。结论肺肝样腺癌临床罕见,预后差;以手术为主的综合治疗能够延长该病早期病例的生存期,中晚期病例多采用放化疗;分子靶向药物、免疫治疗的个体化治疗对于不同患者显示出不同的治疗效果。

Objective To study the clinical features,diagnosis,treatment and prognosis of hepatoid adenocarcinoma of the lung(HAL).Methods The literatures related to HAL published on China Hospital Knowledge Database(CHKD),Wanfang Medical Network and Pubmed database,reported from 1981-2019 were retrieved.Results The related literatures involved 54 papers altogether 61 cases.The data showed that the incidence of HAL was most common in middle-aged and elderly men who smoke,and the incidence ratio of male to female was 14:1.The main clinical manifestations were cough,expectoration,sputum with blood,shortness of breath,chest tightness,chest pain and other symptoms.Spiral CT scan of the chest showed that the tumor was mostly located in the upper lobe of the lung.In most cases,immunohistochemical staining showed positive expression of alpha-fetoprotein(AFP)and hepatocyte antigen.Treatments included surgery,radiotherapy and chemotherapy,molecular targeted drug therapy and immunotherapy.The average survival time of the patients with surgery as the main treatment method was 39 months,and the average survival time of the death cases was 12 months.Conclusions HAL is rare and has a poor prognosis.Operation based comprehensive treatment can improve the survival time of patients at the early stage of the disease.Chemotherapy and radiotherapy are mostly used in the middle and late cases.Molecular targeted drugs,immunotherapy individualized treatment for different patients show different therapeutic effects.