原发性肺癌和肺外恶性肿瘤气管支气管转移的临床特征与对比分析

Clinical features and comparative analysis of primary lung cancer and extrapulmonary malignant tumor with tracheal bronchial metastasis

目的探讨原发性肺癌同步性气管支气管转移(EEM)、原发性肺癌异时性EEM、肺外恶性肿瘤EEM的临床特征。方法回顾性分析2018年1月至2021年6月本院原发性肺癌EEM和肺外恶性肿瘤EEM患者的临床表现、分期、电子支气管镜、影像学、病理学等资料并比较。结果 (1)原发性肺癌同步性EEM总发生率0.70%, 均为中晚期肺癌, 影像学EEM诊断率为53.8%。原发性肺癌异时性EEM总发生率为0.54%, Ⅰ~Ⅲ期肺癌的患者均可能发生。影像学EEM诊断率为80.0%。肺外恶性肿瘤EEM7例, 影像学诊断率为85.7%;(2)原发性肺癌同步性EEM和异时性EEM患者在年龄、性别、原发性病灶和EEM位置、病理类型、影像学EEM病灶诊断阳性率、电子支气管镜EEM病变征象等方面差异无统计学意义(P>0.05);(3)原发性肺癌异时性EEM和肺外恶性肿瘤EEM病灶数量、平均复发时间、影像学EEM病灶诊断阳性率和电子支气管镜EEM病灶征象上差异无统计学意义(P>0.05), 相比原发性肺癌异时性EEM, 肺外恶性肿瘤更多的发生叶支气管及以下的EEM(P=0.01)和Ⅳ型EEM(P=0.05)。结论原发性肺癌EEM发生率低, 各分期均可发生, 影像学检查可能会漏诊, 电子支气管镜对发现EEM具有一定的作用。

Objective To investigate the clinical characteristics of synchronous and metachronous endotracheal/endobronchial metastases(EEM)of primary lung cancer,and EEM of extrapulmonary malignancy.Methods Data on clinical manifestations,staging,fibroptic bronchoscopic pattern,imaging and pathologic studies of EEM in patients with primary lung cancer or extrapulmonary malignancy in our hospital between January 2018 and June 2021 were reviewed and compared.Results(1)Overall,synchronous EEM of primary lung cancer was noted in 0.70%of the patients,among whom,all were with intermediate or advanced lung cancers,and 53.8%were identified by imaging studies;metachronous EEM of primary lung cancer was noted in 0.54%of the patients,among whom,stages I-III can be seen,and 80.0%were identified by imaging studies.There were 7 patients with EEM of extrapulmonary malignancy,85.7%of whom were identifed by imaging studies.(2)The age,gender,culprit lesion,EEM site,as well as the pathologic type,detection rate by imaging studies,fibroptic bronchoscopic pattern of the EEM,did not vary statistically between the patients with synchronous and metachronous EEM of primary lung cancer(P>0.05).(3)The number of EEM lesions,mean time to recurrence,and detection rate by imaging studies and fibroptic bronchoscopic pattern of the EEM did not vary statistically between the patients with synchronous EEM of primary lung cancer and those with EEM of extrapulmonary malignancy(P>0.05).Compared with metachronous EEM of primary lung cancer,EEM of extrapulmonary malignancy was more likely found in lobar or higher-order generations of bronchi(P=0.01),and with typeⅣlesions(P=0.05).Conclusion EEM of primary lung cancer is rarely seen but can occur in all stages of the cancer.Imaging studies may sometimes miss the diagnosis.Fibroptic bronchoscopy has a certain role in the detection of EEM.