肺原发浸润性黏液腺癌的临床病理和CT特征及预后分析

To Compare the Clinicopathological,CT Features and Prognosis of Primary Pulmonary Invasive Mucinous Adenocarcinoma

目的探讨肺原发浸润性黏液腺癌(PPIMA)的临床病理和CT特征及其预后影响因素,为临床工作正确诊断及预后评估提供依据。方法回顾性分析2013年1月至2019年12月就诊于本院经手术或穿刺活检病理证实为PPIMA患者86例,根据CT征象将其分为结节型组71例,肺炎型组15例,采用卡方检验或t检验比较两组患者的CT征象及临床病理特征;采用Cox模型进行单因素及多因素预后分析,Kaplan-Meir法计算生存率,并用Log-rank法检验。结果PPIMA的CT表现主要分为结节型与肺炎型伴假空洞或空泡征、"血管造影征"、病理性支气管征、"碎石路征"、胸膜牵拉等,两组增强扫描均呈轻-中度强化。肺炎型、临床分期、最大径、CYFRA21-1、CEA、CA12-5与PPIMA患者的预后显著相关(P均<0.05),多因素分析显示肺炎型、临床分期、治疗前血清CYFRA21-1是患者死亡的独立预后危险因素(P均<0.05)。结论CT征象可帮助诊断PPIMA,肺炎型较结节型的3年生存率低,血清肿瘤标志、临床分期也是影响PPIMA生存预后的重要因素。

Objective To investigate the clinicopathological and CT features of primary invasive lung mucinous adenocarcinoma and its prognostic factors,so as to provide help of diagnosis and prognostic evaluation.Methods A retrospective analysis of 86 patients with primary infiltrating mucinous adenocarcinoma of the lung confirmed by surgery or biopsy from 2013 to 2019 in our hospital were retrospectively analyzed.According to CT signs,they were divided into the nodule type group(71 cases)and the pneumonia type group(15 cases).The chi-square test or t-test was used to compare CT signs and clinicopathological characteristics of the two groups.The cox model was used for univariate and multivariate prognostic analysis,Kaplan-Meir method was used to calculate the survival rate,and log-rank method was used for testing.Results The CT findings of primary invasive mucinous adenocarcinoma of the lung were mainly divided into nodular type and pneumonia type with false cavity or vacuole sign,angiographic sign,pathological bronchial sign,lithotripsy sign,pleural traction,etc.The two groups both showed mild to moderate enhancement with contrast materials.The prognosis of patients with pneumonia type,clinical stage,maximum diameter,CYFRA21-1,CEA,CA125 was significantly correlated with the prognosis of patients with PPIMA(all P<0.05).Multivariate analysis showed that pneumonia type,clinical stage,and serum CYFRA21-1 before treatment were independent prognostic risk factors for death of patients(all P<0.05).Conclusion CT signs can help to diagnose PPIMA.The 3-year survival rate of pneumonia type is lower than that of the nodule type.Serum tumor markers and clinical stage are also important factors affecting survival and prognosis of PPIMA.