以脑转移为首发症状的老年肺癌患者影像学特征分析

Clinicopathological characteristics of elderly lung cancer patients with brain metastasis

目的 探讨以脑转移为首发的老年肺癌患者的临床病理特征研究。方法 选择2016年1月至2019年1月在成都市第五人民医院肿瘤科治疗的老年肺癌脑转移患者220例作为研究对象,分析患者临床病理特征。结果 220例患者中,共发现脑转移病灶396个,其中腺癌、鳞状细胞癌患者累及顶叶比较最高,分别为54.5%、64%,而小细胞癌累及枕叶比较最高为55.3%,差异有统计学意义(P<0.05)。不同病理类型肺癌中,腺癌以多发病灶比例最高,鳞状细胞癌以单发病灶比例最高,小细胞癌单发病灶及多发病灶比例相当(P<0.05)。腺癌、小细胞癌以结节性强化病灶比例最高,鳞状细胞癌以环形强化病灶比例最高。220例患者中,共发现瘤周水肿162例,其中腺癌、鳞状细胞癌以重度水肿比例最高,小细胞癌瘤周水肿分布相当。结论 肺癌脑转移作为最常见的远处转移形式,其原发病灶以肺腺癌多见,多累及顶叶和枕叶;病灶常多发,亦可单发,肿瘤分化程度越高,瘤周水肿越严重,对临床可疑肺癌脑转移患者行影像学检查十分必要。

Objective To investigate the clinicopathological characteristics of elderly lung cancer patients with brain metastasis as the first episode.Methods A total of 220 elderly patients with brain metastases from lung cancer treated in the Department of Oncology of Chengdu Fifth People’s Hospital from January 2016 to January 2019 were selected as subjects.The clinicopathological characteristics of the patients were analyzed.Results A total of 396 brain metastatic lesions were found in 220 patients,among which the proportion of adenocarcinoma and squamous cell carcinoma involving the parietal lobe was the highest(54.5% and 64%,respectively),while the proportion of small cell carcinoma involving the occipital lobe was the highest(55.3%,respectively),the difference was statistically significant(P<0.05).Among different pathological types of lung cancer,adenocarcinoma had the highest proportion of multiple lesions,squamous cell carcinoma had the highest proportion of single lesions,and small cell carcinoma had the same proportion of single lesions and multiple lesions(P<0.05).Adenocarcinoma and small cell carcinoma had the highest proportion of nodular enhancement lesions,while squamous cell carcinoma had the highest proportion of ring enhancement lesions.Peridumoral edema was found in 162 of the 220 patients,with the highest proportion of severe edema in adenocarcinoma and squamous cell carcinoma,and the distribution of periumoral edema in small cell carcinoma was similar.Conclusion Brain metastasis of lung cancer is the most common form of distant metastasis.Adenocarcinoma of lung is the most common primary lesion,which accumulates in parietal and occipital lobes.The lesions are often multiple or single.The higher the degree of tumor differentiation,the more serious the peri-tumor edema is.Imaging examination is very necessary for patients with clinically suspected lung cancer with brain metastasis.