Ruffini Enrico, Rena Ottavio, Oliaro Alberto, Filosso Pier Luigi, Bongiovanni Massimo, Arslanian Anna, Papalia Esther, Maggi Giuliano
Department of Thoracic Surgery, University of Torino, 3, Via Genova, 10126 Turin, Italy.
Eur J Cardiothorac Surg. 2002 Nov;22(5):701-7. doi: 10.1016/s1010-7940(02)00481-5.
To analyze and compare clinico-pathologic characteristics and survival between lung tumors with mixed histologic pattern and our population of resected lung tumors with single histology in the same period.
From January 1993 to December 1999, 1158 patients received resection for lung tumors. Of these, 59 (5.1%) presented a mixed histologic pattern on the surgical specimen. There were 48 men and 11 women (mean age 64 years, range 43-79). Three groups of tumors were identified: adenosquamous carcinoma, combined neuroendocrine + non-neuroendocrine carcinoma (NNEC) and biphasic tumors (epithelial + mesenchymal malignant components) represented by carcinosarcoma and blastoma. The combined neuroendocrine tumors were further divided in small cell lung carcinoma (SCLC) + large cell neuroendocrine carcinoma (LCNEC)/NNEC and other neuroendocrine tumors/NNEC. Clinico-pathologic characteristics, pTNM and survival were analyzed and compared to our population of resected lung tumors with single histology.
There were 33 adenosquamous carcinomas, 19 combined SCLC+LCNEC/NNEC, two other neuroendocrine tumors/NNEC and five biphasic tumors (three carcinosarcomas and two blastomas). Among adenosquamous carcinomas, high cell grading (G2 or G3), advanced stage (IIIa or higher) and intratumoral perineural invasion were significantly more evident than in the single histology population. Among combined neuroendocrine/NNEC, high cell grading (G3) and intratumoral vascular invasion were significantly more evident than in the single histology population. Among biphasic tumors, all were at early stages and showed high cell grading (G3). Three-year survival rates were 46% in the single histology group, 28% in the adenosquamous group and 21% in the combined SCLC + LCNEC/NNEC. The difference among the three groups was significant (P = 0.013). Median survival of biphasic tumors was 19 months (range 8-37).
Lung tumors with mixed histologic pattern are rare tumors. Adenosquamous carcinoma and combined SCLC + LCNEC/NNEC present a more aggressive clinico-pathologic behaviour and reduced survival as compared to the single histology population of resected lung tumors.
分析并比较具有混合组织学模式的肺肿瘤与同期接受手术切除的单一组织学类型肺肿瘤患者的临床病理特征及生存率。
1993年1月至1999年12月，1158例患者接受了肺肿瘤切除术。其中，59例（5.1%）手术标本呈现混合组织学模式。男性48例，女性11例（平均年龄64岁，范围43 - 79岁）。确定了三组肿瘤：腺鳞癌、神经内分泌 + 非神经内分泌癌联合（NNEC）以及以癌肉瘤和母细胞瘤为代表的双相肿瘤（上皮 + 间充质恶性成分）。联合神经内分泌肿瘤进一步分为小细胞肺癌（SCLC）+ 大细胞神经内分泌癌（LCNEC）/NNEC和其他神经内分泌肿瘤/NNEC。分析并比较其临床病理特征、pTNM及生存率与同期接受手术切除的单一组织学类型肺肿瘤患者。
有33例腺鳞癌、19例联合SCLC + LCNEC/NNEC、2例其他神经内分泌肿瘤/NNEC以及5例双相肿瘤（3例癌肉瘤和2例母细胞瘤）。在腺鳞癌中，高细胞分级（G2或G3）、晚期（IIIa期或更高）及肿瘤内神经周围侵犯比单一组织学类型人群更为明显。在联合神经内分泌/NNEC中，高细胞分级（G3）及肿瘤内血管侵犯比单一组织学类型人群更为明显。在双相肿瘤中，均处于早期且显示高细胞分级（G3）。单一组织学类型组的三年生存率为46%，腺鳞癌组为28%，联合SCLC + LCNEC/NNEC组为21%。三组之间差异有统计学意义（P = 0.013）。双相肿瘤的中位生存期为19个月（范围8 - 37个月）。
具有混合组织学模式的肺肿瘤是罕见肿瘤。与单一组织学类型的手术切除肺肿瘤人群相比，腺鳞癌和联合SCLC + LCNEC/NNEC表现出更具侵袭性的临床病理行为及更低的生存率。
