您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (9): 73-78.doi: 10.6040/j.issn.1671-7554.0.2016.1387

• 临床医学 • 上一篇    下一篇

原发性中央型和周围型肺鳞癌临床病理学及预后差异

李星凯1,刘战业2,姜运峰3,李军1   

  1. 1.山东大学附属省立医院胸外科, 山东 济南 250012;2.曹县人民医院心胸外科, 山东 曹县 274400;3.山东大学第二医院胸外科, 山东 济南 250012
  • 收稿日期:2016-10-26 出版日期:2017-09-10 发布日期:2017-09-10
  • 通讯作者: 李军. E-mail:929941448@qq.com E-mail:929941448@qq.com
  • 基金资助:
    山东省自然科学基金(ZR2013HM064)

Clinicopathological factors and prognosis between primary central and peripheral lung squamous cell carcinoma

LI Xingkai1, LIU Zhanye2, JIANG Yunfeng3, LI Jun1   

  1. 1. Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250012, Shandong, China;
    2. Department of Cardiothoracic Surgery, the County Peoples Hospital of Caoxian, Caoxian 274400, Shandong, China;
    3. Department of Thoracic Surgery, the Second Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2016-10-26 Online:2017-09-10 Published:2017-09-10

PDF (PC)

557

摘要： 目的 回顾性分析原发性肺鳞癌患者临床病理特征及预后,为肺鳞癌诊治提供临床依据。 方法 选择2009年1月至2013年12月收治的447例原发性肺鳞癌患者,其中中央型173例,周围型274例。针对不同变量类型分别采用t检验、 χ2检验、非参数秩和检验比较各变量是否有统计学差异,采用Mantel-Haenszel χ2检验确定两个有序分类变量之间是否存在线性趋势。采用Kaplan-Meier法绘制生存曲线,以Log-rank法比较不同生存曲线的差异。 结果 原发性中央型和周围型肺鳞癌患者在男女构成比、年龄、病理特征、手术方式、不同肿瘤直径及分化程度的淋巴结转移状况、不同淋巴结转移分期间预后等方面的差异具有统计学意义(P均<0.05)。原发性中央型肺鳞癌1、3、5年生存率分别为92.70%、53.60%、33.76%,原发性周围型肺鳞癌分别为97.11%、70.72%、40.81%,二者预后差异具有统计学意义(χ2=9.561, P<0.001)。 结论 原发性中央型和周围型肺鳞癌患者在男女构成比上的差异具有统计学意义。原发性中央型肺鳞癌较周围型易于发生淋巴结转移,预后更差,且发病年龄较周围型有年轻化趋势。肿瘤分化程度及大小与淋巴结转移关系密切,低分化、肿瘤直径≥3 cm淋巴结转移率增高。

关键词: 病理特征, 鳞状细胞癌, 肺癌, 淋巴结转移, 预后

Abstract: Objective To study the clinicopathological features and the prognosis of primary lung squamous cell carcinoma retrospectively and to provide effective methods for diagnosis and treatment. Methods A retrospective study of the clinical data of 447 primary lung cancer patients from January 2009 to December 2012 was made, including 173 cases of central squamous carcinoma and 274 cases of peripheral lung squamous carcinoma. Students t test, Pearson chi-square test, and parametric test of rank transformation were conducted to identify whether there is a significant difference in the clinicopathological factors between central or peripheral lung squamous cell carcinoma. The survival curve was drawn by Kaplan-Meier method, while different survival curves were compared by Log-rank method. Results The difference of sex, age, pathological features, surgical methods, lymph node metastasis of different tumor diameter and differentiated degree, prognosis of lymph node metastases staging were statistically significant. The 1, 3 and 5 year 山 东 大 学 学 报 (医 学 版)55卷9期 -李星凯,等.原发性中央型和周围型肺鳞癌临床病理学及预后差异 \=-survival rate of central squamous carcinomas was 92.70%, 53.60% and 33.76% respectively, and that of peripheral squamous carcinoma was 97.11%, 70.72% and 40.81%. The prognosis between central and peripheral lung squamous cell carcinoma was significantly different(χ2=9.561, P<0.001). Conclusion The constituent ratio between the male and the female showed statistical difference in peripheral and central lung squamous cell carcinoma. Compared with peripheral lung squamous cell carcinoma, central type had a higher rate of lymph node metastasis, poorer prognosis and youth oriented tendency. In addition, it revealed that the rate of lymph node metastasis was positively related with an increasing size and poorer differentiation of the tumor.

Key words: Squamous cell carcinoma, Lung cancer, Lymph node metastasis, Pathological features, Prognosis

中图分类号: 

  • R734.2
[1] Sereno M, Esteean IR, Zambrana F, et al. Squamous-cell carcinoma of the lungs: is it really so different?[J]. Crit Rev Oncol Hematol, 2012, 84(3): 327-339.
[2] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[3] Tse LA, Yu TS, Qiu H, et al. Lung cancer decreased sharply in first 5 years after smoking cessation in Chinese men[J]. J Thorac Oncol, 2011, 6(10): 1670-1676.
[4] Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines[J]. Chest, 2013, 143(5 Suppl): e211S-e250S.
[5] Flores RM, Nicastri D, Bauer T, et al. Computed tomography screening for lung cancer: mediastinal lymph node resection in stage IA nonsmall cell lung cancer manifesting as subsolid and solid nodules[J]. Ann Surg, 2017, 265(5):1025-1033.
[6] Saijo T, Ishii G, Nagai K, et al. Differences in clinicopathological and biological features between central-type and peripheral-type squamous cell carcinoma of the lung[J]. Lung Cancer, 2006, 52(1): 37-45.
[7] 王威, 李玉, 高松, 等. 中心型肺鳞癌侵及支气管壁深度与淋巴结转移相关性研究[J]. 中外医疗, 2012, 31(11): 9-10. WANG Wei, LI Yü, GAO Song, et al. Study on the relevancy between the invasion depth of bronchus by hilar type squamous cell carcinoma of lung and the lymph node megastasis[J]. China Foreign Medical Treatment, 2012, 31(11): 9-10.
[8] Shimosato Y, Suzuki A, Hashimoto T, et al. Prognostic implications of fibrotic focus(scar)in small peripheral lung cancers[J]. Am J Surg Pathol, 1980, 4(4): 365-373.
[9] Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6): 1471-1474.
[10] 支修益, 吴一龙, 马胜林, 等. 原发性肺癌诊疗规范(2011年版)[J]. 中国肺癌杂志, 2012, 15(12): 677-688.
[11] Zheng R, Zeng H, Zhang S, et al. National estimates of cancer prevalence in China, 2011[J]. Cancer Lett, 2016, 370(1): 33-38.
[12] 李文兵, 高德伟, 卢文宁, 等. 80岁以上老年非小细胞肺癌切除术后并发症及预后分析[J]. 解放军医学杂志, 2014, 39(10): 823-825. LI Wenbing, GAO Dewei, LU Wenning, et al. Analysis of complications and outcomes after pulmonary resection in patients aged 80 years or over with non-small cell lung cancer[J]. Medical Journal of Chinese Peoples Liberation Army, 2014, 39(10): 823-825.
[13] Takagi H, Matsui M, Umemoto T. Long-term survival of VATS versus open lobectomy[J]. Ann Thorac Surg, 2011, 92(1): 409-410.
[14] Shi W, Zhang W, Sun H, et al. Sleeve lobectomy versus pneumonectomy for non-small cell lung cancer: a meta-analysis[J]. World J Surg Oncol, 2012, 10(1): 1-9.
[15] Varlotto JM, Yao AN, Decamp MM, et al. Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival[J]. Int J Radiat Oncol Biol Phys, 2015, 91(4): 765-773.
[16] 王长利, 岳东升, 张真发, 等. 非小细胞肺癌1638例治疗及预后探讨[J]. 中华外科杂志, 2011, 49(7): 618-622. WANG Changli, YUE Dongsheng, ZHANG Zhenfa, et al. Treatment and prognostic analysis of 1638 patients with non-small cell lung cancer[J]. Chinese Journal of Surgery, 2011, 49(7): 618-622.
[17] Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1(less than hilar)non-small cell carcinoma: results of the American college of Surgery Oncology Group Z0030 Trial[J]. J Thorac Cardiovasc Surg, 2011, 141(3):662-670.
[18] 马军亮, 刘伦旭, 蒲强, 等. 肺鳞癌和肺腺癌胸内淋巴结转移相关因素分析[J]. 中国肿瘤临床, 2009, 36(20): 1156-1159. MA Junliang, LIU Lunxu, PU Qiang, et al. Analysis of risk factor for lymph node metastasis in thoracic cavity of squamous cell lung cancer and adenocarcinoma[J]. Chinese Journal of Clinical Oncology, 2009, 36(20):1156-1159.
[19] Flider DB, Port JL, Korst RJ, et al. Tumor size is a determinant of stage distribution in T1 non-small cell lung cancer[J]. Chest, 2005, 128(4): 2304-2308.
[20] Fukui T, Katayama T, Ito S, et al. Clinicopathological features of small-sized non-small cell lung cancer with mediastinal lymph node metastasis[J]. Lung Cancer, 2009, 66(3): 309-313.
[21] 李玉, 李厚文, 胡永校. 肺癌淋巴结转移规律的临床研究[J]. 中华胸心血管外科杂志, 2000, 16(1): 10-12. LI Yü, LI Houwen, HU Yongxiao, et al. Clinical study of lymph node metastasis in lung cancer[J]. Chinese Journal of Thoracic and Cardiovascular Surgery, 2000, 16(1): 10-12.
[22] 李军, 李玉, 玉寒冰, 等. 中心型肺癌侵袭深度与淋巴结转移的关系[J]. 中国肺癌杂志, 2009, 12(6): 466.
[23] 朱斌, 柳仓生. 非小细胞肺癌的淋巴结转移相关因素及规律的探讨[J]. 中国肿瘤临床, 2012, 39(15): 1115-1118. ZHU Bin, LIU Cangsheng. Correlation factor and incidence of lymph node metastasis in non-small cell lung cancer[J]. Chinese Journal of Clinical Oncology, 2012, 39(15): 1115-1118.
[1] 栗英林,宋道庆,徐忠华. 应用生物信息学方法分析肾透明细胞癌中FKBP11的表达[J]. 山东大学学报 (医学版), 2020, 1(9): 45-51.
[2] 孟朝暾,李钦, 孙卉,邬信芳,孙文凯,高伟. 白细胞介素18单核苷酸多态性与73例喉鳞状细胞癌易感性的关联性[J]. 山东大学学报 (医学版), 2020, 1(9): 58-63.
[3] 史爽,李娟,米琦,王允山,杜鲁涛,王传新. 胃癌miRNAs预后风险评分模型的构建与应用[J]. 山东大学学报 (医学版), 2020, 1(7): 47-52.
[4] 路璐,孙志钢,张楠. 继发性嗜血细胞综合征1例[J]. 山东大学学报 (医学版), 2020, 1(7): 122-124.
[5] 底学敏,牛书雷,赵静,杜随,于慧敏,张宏涛,王娟. CT引导下125I粒子植入治疗晚期胃癌淋巴结转移[J]. 山东大学学报（医学版）, 2017, 55(9): 79-84.
[6] 宗帅,肖东杰,刘华,郏雁飞,马晓丽,李焕杰,黎娉,郑燕,汪运山. CSN5在胃癌中的表达及与患者预后的相关性[J]. 山东大学学报（医学版）, 2017, 55(7): 12-16.
[7] 曾海燕,李睿,孙新东,谢鹏,孟雪,范秉杰,李万龙,袁双虎. 局限期小细胞肺癌患者预防性脑照射后脑转移的关联分析:双中心研究[J]. 山东大学学报（医学版）, 2017, 55(7): 61-66.
[8] 孙启晶,陈方方,李春晓,张才擎. PNI及HGB评估中晚期非小细胞肺癌患者预后的临床价值[J]. 山东大学学报（医学版）, 2017, 55(4): 55-59.
[9] 董尧,宋亚林,田涛,高建国. 确诊8年未经治疗却无明显进展的阴茎恶性黑色素瘤1例报道[J]. 山东大学学报（医学版）, 2017, 55(3): 125-126.
[10] 林家香,郭子嘉,苏鹏,王晓,郭雅欣,吴晓娟,相磊,周志强, 王妍,崔秀杰,潘爱凤,郭成浩. 致癌蛋白CIP2A在乳腺导管上皮恶变中的作用及预测浸润性导管癌患者预后的能力[J]. 山东大学学报（医学版）, 2017, 55(3): 100-106.
[11] 柴树德. 我国放射性粒子植入治疗支气管肺癌现状与技术创新[J]. 山东大学学报（医学版）, 2017, 55(2): 4-7.
[12] 戴建建,袁冰,张颖,林琦,袁苑,韩明勇. CT引导下125I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察[J]. 山东大学学报（医学版）, 2017, 55(2): 32-37.
[13] 林琦,张颖,戴建建,徐瑞彩,杨琦,耿宝成,韩明勇. CT引导放射性125I粒子植入治疗23例浅表淋巴结转移瘤[J]. 山东大学学报（医学版）, 2017, 55(2): 38-44.
[14] 周兰兰,潘学谊,郭煜. 48例急性混合细胞表型白血病患者的临床特征及预后[J]. 山东大学学报（医学版）, 2017, 55(2): 79-83.
[15] 张希英,翟春颜,李劲松,韩博. 中国尤文肉瘤患者EZH2蛋白表达与临床病理学参数及预后的关系[J]. 山东大学学报（医学版）, 2017, 55(2): 84-91.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发