外科手术与内镜介入治疗可切除肺腺样囊性癌的疗效比较

Comparative study of surgical and endoscopic treatment of resectable lung adenoid cystic carcinoma

目的探讨外科手术与内镜介入两种方法治疗可切除肺腺样囊性癌的临床疗效。方法回顾性研究。纳入天津市胸科医院2010年1月—2017年12月收治的可切除肺腺样囊性癌患者25例。其中,男18例、女7例,年龄42~87(56.6±12.5)岁。25例患者根据治疗方式不同分为2组,行内镜介入治疗的11例患者为内镜组,行外科手术治疗的14例患者为手术组。对比2组患者手术时间、术中出血量、术后住院时间,以及2组患者围手术期呼吸系统疾病、心血管系统疾病并发症发生情况;术后定期随访,比较2组患者肿瘤复发和转移情况,以及总体生存期和无复发生存期。结果2组患者性别、年龄、体质量指数及肿瘤大小、位置、分期等基线资料比较,差异均无统计学意义(P值均>0.05)。患者均顺利完成手术,无R2切除患者。手术组患者手术时间(187.4±37.6)min、术中出血量为(107.2±31.3)mL,分别大于内镜组的(105.8±19.6)min、(45.89±14.66)mL,差异均有统计学意义(t=7.00、6.51,P值均<0.001)。手术组发生呼吸系统并发症8例、心血管系统并发症3例,内镜组发生呼吸系统并发症4例、心血管系统并发症2例,差异均无统计学意义(P值均>0.05)。25例患者术后随访6~91个月,中位随访时间62.3个月。随访期间,手术组患者死亡2例,内镜组患者死亡5例。内镜组术后胃肠部位转移1例、局部进展4例,手术组术后同侧肺转移1例、无局部复发,2组复发转移率比较,差异无统计学意义(P=0.056)。内镜组总体生存期平均为61.9[95%可信区间(CI)48.0~75.9]个月、无复发生存期平均为50.7(95%CI 31.6~69.8)个月,分别短于手术组的83.1(95%CI 75.8~90.4)个月、86.7(95%CI 78.6~94.8)个月,仅无复发累积生存期差异有统计学意义(χ^(2)=5.46,P=0.020)。结论外科手术治疗可切除的肺腺样囊性癌,患者总体生存期和无复发生存期优于内镜治疗,且手术治疗的患者复发率较低,因此推荐其为可切除的肺腺样囊性癌的首选治疗方案。

Objective To investigate the clinical effect of surgical and endoscopic treatments on resectable lung adenoid cystic carcinoma.Methods This study was a retrospective study.Twenty-five patients with resectable lung adenoid cystic carcinoma,including 18 males and 7 females aged 42–87(56.6±12.5)years who were admitted to Tianjin Chest Hospital between January 2010 and December 2017,were enrolled.The patients were divided into two groups according to treatment,namely,the endoscopy group(n=11)and surgery group(n=14).Operation time,intraoperative blood loss,postoperative hospital stay,and perioperative complications(respiratory disease,cardiovascular disease)were compared between the two groups.Tumor recurrence and metastasis were compared during the follow-up period.The overall survival and recurrence-free survival were compared between the two groups during regular follow-up.Results No significant differences in gender,age,body mass index,tumor size,tumor location,and tumor stage were found between the two groups(all P values>0.05).Surgery was successfully completed in all patients,and no R2 resection.The operative time([187.4±37.6]min),and intraoperative bleeding([107.2±31.3]mL)of the patients in the surgery group were higher than those of the endoscopy group([105.8±19.6]min,and[45.89±14.66]mL,respectively)with statistically significant differences(t=7.00,6.51;all P values<0.001).In the surgery group,8 patients had respiratory complication,3 patients had cardiovascular complication.In the endoscopy group,4 patients had a respiratory complication,2 patients cardiovascular complication.No significant difference in the incidence of complications was found between the two groups(all P values>0.05).The patients were followed up for 6–84 months with a median follow-up of 62.3 months.Two patients from the surgery group and five patients from the endoscopy group died during the follow-up period.In the endoscopy group,five cases of postoperative recurrence,including one case of gastrointestinal metastasis and four cases of local progression,were recorded.In the surgery group,one case had an ipsilateral lung metastasis without local recurrence.No significant differences in recurrence and metastasis rates were observed between the two groups(P=0.056).The overall survival([61.9,95%credibility interval 48.0-75.9]months)and recurrence-free survival([50.7,95%credibility interval 31.6-69.8]months)in the endoscopy group were shorter than those in the surgery group([83.1,95%credibility interval 75.8-90.4]and[86.7,95%credibility interval 78.6-94.8]months,respectively).The recurrence-free survival has statistically significant differences(χ^(2)=5.46,P=0.020).Conclusion Surgical treatment of resectable lung adenoid cystic carcinoma has better overall 5-year progression-free cumulative survival and recurrence-free cumulative survival and lower recurrence rate than endoscopic treatment.Therefore,it is worthy of clinical recommendation as a treatment plan for resectable lung adenoid cystic cancer.