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目的 探讨支气管肺类癌, 包括典型类癌(typical carcinoid, TC)及不典型类癌(atypical carcinoid, ATC)的临床特点及手术治疗经验, 并分析可能的预后因素。 方法 回顾总结2000年1月至2014年1月在北京协和医院接受手术治疗并经病理检查证实为TC或ATC的57例患者临床资料, 同时进行生存和预后分析。 结果 57例患者中男性35例, 女性22例, 中位年龄49岁(12~85岁), 中位病程3个月(1~156个月), 临床症状缺乏特异性, 12例伴有异位促肾上腺皮质激素综合征。术后病理确诊TC 39例, ATC 18例; Ⅰ期为主, 共41例, Ⅱ期和Ⅲ期各7例, IV期2例。5年、10年存活率分别为92.4%及89.0%。Kaplan-Meier分析显示, 病理类型、T分期及N分期的P值分别为0.001、0.000、0.004。 结论 支气管肺TC及ATC缺乏特异性临床表现, 手术效果良好, 病理分型、肿瘤T分期和N分期可能是预后的影响因素。 Abstract:Objective The aim of this study was to evaluate the clinical features and the surgical experience of patients with bronchopulmonary carcinoids, including typical carcinoid (TC) and atypical carcinoid (ATC), and to analyze the potential prognostic factors. Methods From January 2000 to January 2014, the clinical data of 57 consecutive cases of bronchopulmonary undergoing surgical resection and confirmed as TC or ATC by pathology in Peking Union Medical College Hospital were retrospectively analyzed; survival and prognostic analysis were also performed. Results There were 35 males and 22 females. The median age was 49(12-85)years old, and the median duration of disease was 3(1-156)months. Clinical symptoms lack specificity, and 12 cases got ectopic adrenocorticotropic hormone syndrome. The postoperative pathological examination confirmed 39 cases of TC and 12 cases of ATC; staging consisted of 41 cases of stage Ⅰ, 7 stage Ⅱ, 7 stage Ⅲ, and 2 stage Ⅳ. The 5-year and the 10-year survival rates were 92.4% and 89.0%, respectively. Kaplan-Meier analysis showed that the P values of pathological type, T stage and N stage were 0.001, 0.000 and 0.004, respectively. Conclusions The clinical features of bronchopulmonary TC and ATC are atypical and these patients have a preferably prognosis after surgery. Pathological types, T stages, and N stages might be the prognostic factors. -
Key words:
- carcinoma, neuroendocrine /
- lung /
- surgery /
- prognosis
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图 1 周围型典型及不典型肺类癌CT均表现为类圆形实性结节, 可见强化, 边界较为光滑, 未见明显分叶、毛刺、胸膜牵拉(箭头)
A、C.典型肺类癌, A为肺窗, C为纵隔窗动脉期; B、D.不典型肺类癌, B为肺窗, D为纵隔窗动脉期
图 3 57例支气管肺类癌患者Kaplan-Meier生存曲线图
A.总生存曲线; B.不同病理类型生存期比较; C.N分期生存期比较; D.T分期生存期比较; TC:典型类癌; ATC:不典型类癌
表 1 57例支气管肺类癌患者一般资料及临床症状
项目 典型肺类癌 不典型肺类癌 P值* 例数(n) 39 18 年龄[M(Q), 岁] 46(12~85) 57(30~67) 0.097 性别(n) 0.600 男性 24 11 女性 15 7 是否吸烟(n) 0.289 是 17 10 否 22 8 肿瘤部位(n) 0.064 外周 23 6 中央 16 12 症状(n) - 咳嗽 5 8 痰中带血 8 4 EAS 11 1 胸闷胸痛 2 3 无症状 13 2 EAS:异位促肾上腺皮质激素综合征; *非正态分布采用非参数检验, 计数资料采用卡方检验 
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表 2 57例支气管肺类癌患者手术情况及病理资料
项目 典型类癌 不典型类癌 P值* 例数(n) 39 18 手术方式(n) - 肺叶 27 11 联合肺叶 3 2 亚肺叶(楔形) 2 2 成形或袖式切除 6 2 全肺切除 1 1 淋巴结清扫或采样(n) - 是 38 17 否 1 1 肿瘤最大径线(x±s, cm) 2.0±1.1 3.8±1.5 0.000 T分期(n) T1 17 2 T2 22 14 T3 0 2 T4 0 0 N分期(n) N0# 34 8 N1 1 6 N2 4 4 N3 0 0 胸膜腔播散(M1a)(n) 0 2 - 肺癌分期(n) 0.000 Ⅰ 34 7 Ⅱ 1 6 Ⅲ 4 3 Ⅳ 0 2 #患者中有2例未行淋巴结清扫或采样, 结合临床及术后随诊考虑无淋巴结转移, 纳入N0分期; *正态分布计量资料采用t检验, 计数资料采用卡方检验
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