细支气管肺泡癌184例临床分析
http://www.100md.com
参见附件(102kb)。
北京医学科学院协和医院 葛 楠 李龙芸 缪若羽
【摘要】研究背景与 目的 根据 WHO1999 年的定义，细支气管肺泡癌( bronchioloalveolar cell carcinoma ， BAC )是肺腺癌中的一个亚型，发病率明显上升，有独特的病理学、影像学特征，有报告提示使用表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI )可使晚期 BAC 患者的完全缓解期延长。本研究探讨细支气管肺泡癌临床症状、误诊、病理类型、影像学特点、诊断、治疗模式及预后。 方法 用统计学方法回顾性分析北京协和医院 1990 年 1 月到 2005 年 12 月期间收治的 184 例细支气管肺泡癌的临床表现、误诊的特点，探讨支气管肺泡癌的治疗新模式及预后。 结果 本组病例占我院同期原发性支气管肺癌的 5.2 ( 184/3534 )，占我院同期肺腺癌的 14.5% ( 184/1265 )，男女之比 1:1.2 ，无症状体检发现者占 27.2% ， BAC 影像学的表现易被误诊为肺炎、肺结核、间质性肺病，误诊比例高达 41.9% ，综合治疗的疗效较单一治疗效果好。临床分期、病理类型、影像学特点、治疗模式是与生存期密切相关的因素。 结论 细支气管肺泡癌与其他非小细胞肺癌亚型相比有自己的特点， 经统计分析本组 BAC 女性较男性发病率高，病理类型主要为单纯的肺泡细胞癌( 47 例， 27.5% )、肺泡癌伴局部浸润( 71 例， 38.6% )、具有肺泡细胞癌特征的腺癌( 41 例， 22.3% ) 3 种，影像学上有浸润型(肺炎样、粟粒样)的特点，易被误诊。对 BAC 的治疗模式应以综合治疗(手术+术后放化疗+分子靶向治疗)为主。对分期晚不能手术的患者采取先化疗后表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI )分子靶向治疗的序贯疗法显示良好的疗效，分析本组符合上述条件的 27 例病例，最长生存期为 97 个月，中位生存期为 25 个月。
【关键词】 细支气管肺泡癌； 治疗； 预后； 生存期
【 Abstract 】 Background & Objective Bronchioloalveolar cell carcinoma (BAC) was defined by the WHO in 1999 to be a subtype of pulmonary adenocarcinoma with unique pathologic and radiologic features. In recent years, there has been a profound increase in the incidence of BAC. It was reported that the complete response (CR) of some advanced BAC patients had been prolonged by the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). This study is intended to investigate the clinical characteristics and symptoms, misdiagnoses, pathology, radiology, diagnoses, modes of treatment and prognoses of BAC. Methods Retrospectively analyze the clinical data of 184 patients of BAC who were admitted by Peking Union Medical College Hospital (PUMCH) from January, 1990 to December, 2005. Statistically Analyze the characteristics of the clinical symptoms and misdiagnoses, and investigate the new treatment modes and prognoses of BAC. Results The cases of this study account for 5.2% (184/3534) of primary bronchiogenic carcinomas and 14.5% (184/1265) of pulmonary adenocarcinomas that were admitted by PUMCH during the same period. The ratio of males to females is 1:1.24. 27.2% of the cases were discovered during health checkups, with no obvious symptoms. Because of its radiological features, BAC could easily be misdiagnosed as pneumonia, pulmonary tuberculosis or interstitial lung disease, and the ratio of the misdiagnosed cases is as high as 41.9%. The curative effect of combined-modality therapy is better than that of single therapy. The prognostic factors that are closely related to survival include the clinical stage, pathological type, radiological features and the mode of treatment. Conclusion Compared with other NSCLCs, BAC has distinctive characteristics. As the statistic analysis reveals, in this study group, the incidence of BAC in females is higher than males. The three major pathological types are pure BAC (47, 27.5%), BAC with focal invasion (71, 38.6%), and adenocarcinoma with BAC features (41, 22.3%). Those with a feature of infiltration (pneumonia-like or miliary pattern) by radiology are more likely to be misdiagnosed. The treatment mode of BAC should be based on combined-modality therapy, e.g., surgery + chemotherapy/ radiotherapy after surgery + molecular targeted therapy.For the advanced BAC patients who are not able to sustain surgery, the sequential therapy of first chemotherapy and then molecular targeted therapy, e.g., EGFR-TKI, has shown considerable effectiveness. In these 27 patients, the maximum survival is 97 months, and the medial survival is 25 months. ......
北京医学科学院协和医院 葛 楠 李龙芸 缪若羽
【摘要】研究背景与 目的 根据 WHO1999 年的定义，细支气管肺泡癌( bronchioloalveolar cell carcinoma ， BAC )是肺腺癌中的一个亚型，发病率明显上升，有独特的病理学、影像学特征，有报告提示使用表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI )可使晚期 BAC 患者的完全缓解期延长。本研究探讨细支气管肺泡癌临床症状、误诊、病理类型、影像学特点、诊断、治疗模式及预后。 方法 用统计学方法回顾性分析北京协和医院 1990 年 1 月到 2005 年 12 月期间收治的 184 例细支气管肺泡癌的临床表现、误诊的特点，探讨支气管肺泡癌的治疗新模式及预后。 结果 本组病例占我院同期原发性支气管肺癌的 5.2 ( 184/3534 )，占我院同期肺腺癌的 14.5% ( 184/1265 )，男女之比 1:1.2 ，无症状体检发现者占 27.2% ， BAC 影像学的表现易被误诊为肺炎、肺结核、间质性肺病，误诊比例高达 41.9% ，综合治疗的疗效较单一治疗效果好。临床分期、病理类型、影像学特点、治疗模式是与生存期密切相关的因素。 结论 细支气管肺泡癌与其他非小细胞肺癌亚型相比有自己的特点， 经统计分析本组 BAC 女性较男性发病率高，病理类型主要为单纯的肺泡细胞癌( 47 例， 27.5% )、肺泡癌伴局部浸润( 71 例， 38.6% )、具有肺泡细胞癌特征的腺癌( 41 例， 22.3% ) 3 种，影像学上有浸润型(肺炎样、粟粒样)的特点，易被误诊。对 BAC 的治疗模式应以综合治疗(手术+术后放化疗+分子靶向治疗)为主。对分期晚不能手术的患者采取先化疗后表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI )分子靶向治疗的序贯疗法显示良好的疗效，分析本组符合上述条件的 27 例病例，最长生存期为 97 个月，中位生存期为 25 个月。
【关键词】 细支气管肺泡癌； 治疗； 预后； 生存期
【 Abstract 】 Background & Objective Bronchioloalveolar cell carcinoma (BAC) was defined by the WHO in 1999 to be a subtype of pulmonary adenocarcinoma with unique pathologic and radiologic features. In recent years, there has been a profound increase in the incidence of BAC. It was reported that the complete response (CR) of some advanced BAC patients had been prolonged by the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). This study is intended to investigate the clinical characteristics and symptoms, misdiagnoses, pathology, radiology, diagnoses, modes of treatment and prognoses of BAC. Methods Retrospectively analyze the clinical data of 184 patients of BAC who were admitted by Peking Union Medical College Hospital (PUMCH) from January, 1990 to December, 2005. Statistically Analyze the characteristics of the clinical symptoms and misdiagnoses, and investigate the new treatment modes and prognoses of BAC. Results The cases of this study account for 5.2% (184/3534) of primary bronchiogenic carcinomas and 14.5% (184/1265) of pulmonary adenocarcinomas that were admitted by PUMCH during the same period. The ratio of males to females is 1:1.24. 27.2% of the cases were discovered during health checkups, with no obvious symptoms. Because of its radiological features, BAC could easily be misdiagnosed as pneumonia, pulmonary tuberculosis or interstitial lung disease, and the ratio of the misdiagnosed cases is as high as 41.9%. The curative effect of combined-modality therapy is better than that of single therapy. The prognostic factors that are closely related to survival include the clinical stage, pathological type, radiological features and the mode of treatment. Conclusion Compared with other NSCLCs, BAC has distinctive characteristics. As the statistic analysis reveals, in this study group, the incidence of BAC in females is higher than males. The three major pathological types are pure BAC (47, 27.5%), BAC with focal invasion (71, 38.6%), and adenocarcinoma with BAC features (41, 22.3%). Those with a feature of infiltration (pneumonia-like or miliary pattern) by radiology are more likely to be misdiagnosed. The treatment mode of BAC should be based on combined-modality therapy, e.g., surgery + chemotherapy/ radiotherapy after surgery + molecular targeted therapy.For the advanced BAC patients who are not able to sustain surgery, the sequential therapy of first chemotherapy and then molecular targeted therapy, e.g., EGFR-TKI, has shown considerable effectiveness. In these 27 patients, the maximum survival is 97 months, and the medial survival is 25 months. ......
您现在查看是摘要介绍页，详见DOC附件(102kb)。