原发性肺黏液腺癌的临床特征及其预后的影响因素研究

Clinical Features and Prognostic Factors of Primary Pulmonary Mucinous Adenocarcinoma

背景目前,原发性肺黏液腺癌(PPMA)的临床特征和预后特点尚不完全明确,且无规范的方案指导其治疗。目的分析PPMA的临床特征,并探讨其预后的影响因素。方法收集郑州大学第一附属医院2015—2019年收治的105例PPMA患者,回顾性分析其临床资料。本研究通过复诊和电话随访等方式随访患者的生存状态,终点事件为死亡,随访截止时间为2021年5月。采用Kaplan-Meier法计算患者的累积生存率,并绘制生存曲线,累积生存率的比较采用log-rank检验;PPMA患者预后的影响因素分析采用多元Cox比例风险回归分析。结果105例PPMA患者中男42例(40.0%),女63例(60.0%)。中位年龄60岁,其中<60岁52例(49.5%),≥60岁53例(50.5%)。临床表现:有临床表现83例(79.0%),其中咳嗽、咳痰39例,胸闷、胸痛19例,咯血15例,发热10例;无临床表现22例(21.0%)。肿瘤大体形态:结节或团块样阴影68例(64.8%);大片状实变影37例(35.2%),其中23例初诊时误诊为肺炎、2例误诊为肺结核。本研究105例PPMA患者1、3、5年累积生存率分别为80.8%、62.9%、42.1%,中位生存时间为56个月。不同年龄、TNM分期、肿瘤标志物表达情况、肿瘤大小及有无淋巴结转移的PPMA患者5年累积生存率比较,差异有统计学意义(P<0.05)。多元Cox比例风险回归分析结果显示,年龄[HR=2.342,95%CI(1.150,4.768)]、TNM分期[HR=8.124,95%CI(3.385,19.495)]、肿瘤大小[HR=3.341,95%CI(1.475,7.567)]、淋巴结转移[HR=6.169,95%CI(2.356,16.156)]是PPMA患者预后的独立影响因素(P<0.05)。结论PPMA好发于中老年女性,无特异性临床表现,主要影像学表现为结节或团块样阴影。本组PPMA患者1、3、5年累积生存率分别为80.8%、62.9%、42.1%,中位生存时间为56个月,且年龄、TNM分期、肿瘤大小、淋巴结转移是PPMA患者预后的独立影响因素。

Background The clinical features and prognostic of primary pulmonary mucinous adenocarcinoma(PPMA)are not completely clear.There is no standardized protocol to guide its treatment.Objective To investigate the clinical features and the prognostic factors of PPMA.Methods The clinical data of 105 PPMA patients admitted to the First Affiliated Hospital of Zhengzhou University from 2015 to 2019 were retrospectively analyzed.In this study,the survival status of patients was followed up by return visit and telephone.The end event was death,and the follow-up ended in May 2021.Kaplan-Meier method was used to calculate cumulative survival of patients and draw survival curves.The cumulative survival rates were compared by log-rank test.The prognostic factors of PPMA patients were analyzed by multivariate Cox proportional hazards regression analysis.Results Among the 105 patients with PPMA,there were 42 males(40.0%)and 63 females(60.0%).The median age was 60 years old,with 52 cases(49.5%)<60 years old and 53 cases(50.5%)≥60 years old.Clinical manifestations:there were 83 cases(79.0%)with clinical manifestations,including cough and expectoration in 39 cases,chest distress and chest pain in 19 cases,hemoptysis in 15 cases and fever in 10 cases.There were 22 cases(21.0%)without clinical manifestation.General morphology of tumor:nodular or mass shadow in 68 cases(64.8%);there were 37 cases(35.2%)of large patchy consolidation,among which 23 cases were misdiagnosed as pneumonia and 2 cases were misdiagnosed as tuberculosis at the initial diagnosis.In this study,the 1-,3-and 5-year cumulative survival rates of 105 PPMA patients were 80.8%,62.9%and 42.1%,respectively.The median survival time was 56 months.There was significant difference in the 5-year cumulative survival rate of PPMA patients with different age,TNM stage,tumor marker expression,tumor size,lymph node metastasis or not(P<0.05).Multivariate Cox proportional hazards regression analysis showed that age[HR=2.342,95%CI(1.150,4.768)],TNM stage[HR=8.124,95%CI(3.385,19.495)],tumor size[HR=3.341,95%CI(1.475,7.567)]and lymph node metastasis[HR=6.169,95%CI(2.356,16.156)]were independent prognostic factors for PPMA patients(P<0.05).Conclusion PPMA tends to occur in middle-aged and elderly women with no specific clinical manifestations,and the main imaging manifestations are nodular or mass like shadows.In this study,the 1-,3-and 5-year cumulative survival rates of PPMA patients were 80.8%,62.9%and 42.1%,respectively.The median survival time was 56 months.Age,TNM stage,tumor size and lymph node metastasis are independent prognostic factors for PPMA patients.