中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

328 例 HRCT 表现为孤立性磨玻璃结节肺癌患者的临床、病理及影像学特征分析

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目的探讨肺内孤立性磨玻璃结节(SGGN)肺癌患者的临床、病理及影像学特征。方法收集 2008 年 1 月至 2017 年 3 月于四川大学华西医院病理科确诊且高分辨率 CT(HRCT)表现为 SGGN 的肺癌患者,对其临床、病理及影像学资料进行分析。结果共纳入 328 例患者,其中 HRCT 表现为 SGGN 的肺癌患者中女性(230,70.1%)多于男性(98,29.9%),总体平均年龄为 54.9 岁。所有 SGGN 均为 IA 或 IB 期腺癌。吸烟患者 48 例,均为男性。自身肿瘤病史 19 例,肿瘤家族史 60 例,其中有肺癌家族史 32 例。病理分型示:非典型增生(AAH)10 例,原位腺癌(AIS)43 例,微浸润腺癌(MIA)71 例,浸润性腺癌(IPA)204 例,其中高-中分化 325 例(99.1%)。免疫组织化学示:ALK-V、ROS-1 及 PDL-1 阳性率分别为 4.2%、13.9% 和 17.8%。影像学分析示:纯 SGGN 149 例(45.4%),混合型 SGGN 179 例(54.6%),病变部位以右肺上叶最常见(138,42.1%)。结节大小、密度、形态和胸膜凹陷征为区别 IPA 与 AAH、AIS、MIA 的重要因素。所有患者平均随访时间为 3.32 个月,均行手术切除治疗,术后至今均未出现肿瘤复发及转移。结论HRCT 表现为 SGGN 的肺腺癌患者中不吸烟女性多于男性,病变部位以右肺上叶最常见,均为早期肺癌,且经手术切除后生存率高。结节大小、密度、形态和胸膜凹陷征为区别 IPA 与 AAH、AIS、MIA 的重要因素。ALK-V、ROS-1 及 PDL-1 在 SGGN 患者中阳性表达率低。

ObjectiveTo analyze the clinical, pathological, and radiological characteristics of solitary ground-glass opacity nodules (SGGN) of the lungs on high-resolution computed tomography (HRCT).MethodsA total of 328 resected SGGN were evaluated with HRCT from January 2008 to March 2018. The clinical, pathological, and radiological characteristics of these cases were analyzed.ResultsThree hundred and twenty-eight adenocarcinomas were observed. Patients with adenocarcinoma in non-smoking women (230, 70.1%) were more than men (98, 29.9%). All SGGN were at the stage IA or IB. Forty-eight patients (all were male) had smoking history, 19 patients with a history of cancer, and 60 patients had a family history of cancer, which including 32 patients with family lung cancer history. However, elevated blood tumor markers were rare in patients. The adenocarcinoma nodules included 10 (3.0%) atypical hyperplasia (AAH), 43 (13.1%) adenocarcinoma in situ (AIS), 71 (21.6%) minimally invasive adenocarcinoma (MIA), and 204 (62.2%) invasive adenocarcinoma (IPA). The positive expression rates of anaplastic lymphoma kinase (ALK-V), proto-oncogene tyrosine-protein kinase ROS (ROS-1) and programmed death ligand 1 (PDL-1) were 4.2% (6/143), 13.9% (20/144) and 17.8% (13/73), respectively. HRCT showed that there were 149 (45.4%) pure SGGN and 179 (54.6%) mixed SGGN, and the most common lesion was the superior lobe of right lung (138, 42.1%). The size, density, shape, and pleural tag of nodules were significant factors that differentiated IPA from AAH, AIS and MIA. All patients were followed up for an average of 3.32 months. All patients underwent surgical excision and no recurrence or metastasis of the tumor had occurred.ConclusionsThe size, density, shape, and pleural tag of SGGN on HRCT are found to be the determinant factors of IPA. Additionally, patients were all at the early clinical stage, and have high survival rate after surgical removal of the nodules. Moreover, the positive expression rate of ALK-V, ROS-1 and PDL-1 are very low in patients with SGGN.

关键词: 孤立性磨玻璃结节; 腺癌; 临床; 病理; 影像学

Key words: Solitary ground-glass opacity nodule; Adenocarcinoma; Clinic; Pathology; Radiology

引用本文: 邱志新, 李为民. 328 例 HRCT 表现为孤立性磨玻璃结节肺癌患者的临床、病理及影像学特征分析. 中国呼吸与危重监护杂志, 2018, 17(5): 470-476. doi: 10.7507/1671-6205.201804007 复制

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