Tian Da-Li, Liu Hong-Xu, Zhang Lin, Yin Hong-Nian, Hu Yong-Xiao, Zhao Hui-Ru, Chen Dong-Yi, Han Li-Bo, Li Yu, Li Hou-Wen
Department of Thoracic Surgery, First Hospital, China Medical University, Shenyang 110001, China.
Lung Cancer. 2003 Nov;42(2):215-20. doi: 10.1016/s0169-5002(03)00286-1.
To investigate the relationship between the clinical features and prognosis in young patients with lung cancer who underwent resection.
Statistical analysis was employed on sex, age, symptoms, diagnosis, treatment and prognosis, in 92 young cases younger than 40 years old among 930 cases with primary lung cancer who underwent surgery from January 1978 to December 1996.
There were 92 young patients with lung cancer, accounting for 9.89% of the total cases. They were 71 male and 21 female patients, with the ratio of 3.38:1. The histological types were 34 squamous cell carcinomas (37%), 30 adenocarcinomas (33%), 26 small cell carcinomas (28%), and two large cell carcinomas (2%). On TNM staging, there were 30 cases in stage I (32.6%), 30 in stage II (32.6%) and 32 in stage III (34.8%). Lobectomy was conducted in 54 patients (59%), pneumonectomy in 36 (39%) and wedge-shaped resection in two cases (2%). The rate of pneumonectomy in young patients was significantly higher than that of 18% in older patients (>40) with lung cancer (P<0.01). 57 patients (62%) received absolutely curative resection; 28 cases (30%), relatively curative resection; seven cases (8%), non-curative resection. The postoperative 5-year-survival was 46% (42/92), in comparison with 34% (288/838) in patients older than 40 receiving operation during the same period, with significant difference between the two groups (P<0.05). The 5-year-survivals in patients with squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma were 68% (23/34), 30% (9/30), 38% (10/26) and 0 (0/2), respectively. The survival in squamous cell cancer was markedly higher than in adenocarcinoma (P<0.01) and in small cell carcinoma (P<0.05). There was no significant difference between adenocarcinoma and small cell cancer. The 5-year-survivals in stage I, II and III were 63% (19/30), 53% (16/30) and 22% (7/32), respectively. There was no significant difference between stage I and II, while remarkable difference was found between stage I and III (P<0.01), and between stage II and III (P<0.05). The 5-year-survival in patients undergoing absolutely curative resection was 67% (38/57), and 14% (4/28) in patients with relatively curative resection, with significant difference (P<0.01). No patient survived longer than the 5th postoperative year in seven cases receiving non-curative resection.
Young patients with lung cancer were more often seen in male than in female. Squamous cell carcinoma accounted for the most part, no statistical difference, however, compared with adenocarcinoma and small cell carcinoma. The pneumonectomy rate in young patients was remarkably higher than that in patients older than 40. The postoperative 5-year-survival in young patients was considerably higher than in patients older than 40 who underwent surgery during the same period. Favorable prognosis was seen in patients with squamous cell carcinoma and undergoing absolutely curative resection, while worse outcome in stage III cancer.
探讨接受手术切除的青年肺癌患者的临床特征与预后之间的关系。
对1978年1月至1996年12月间930例行手术治疗的原发性肺癌患者中92例年龄小于40岁的青年患者的性别、年龄、症状、诊断、治疗及预后进行统计分析。
92例青年肺癌患者，占总病例数的9.89%。其中男性71例，女性21例，男女比例为3.38:1。组织学类型为鳞状细胞癌34例（37%）、腺癌30例（33%）、小细胞癌26例（28%）、大细胞癌2例（2%）。TNM分期：Ⅰ期30例（32.6%），Ⅱ期30例（32.6%），Ⅲ期32例（34.8%）。54例（59%）患者行肺叶切除术，36例（39%）行全肺切除术，2例（2%）行楔形切除术。青年患者全肺切除率显著高于40岁以上老年肺癌患者的18%（P<0.01）。57例（62%）患者接受了根治性切除；28例（30%）为相对根治性切除；7例（8%）为非根治性切除。术后5年生存率为46%（42/92），同期40岁以上接受手术患者的5年生存率为34%（288/838），两组间差异有统计学意义（P<0.05）。鳞状细胞癌、腺癌、小细胞癌和大细胞癌患者的5年生存率分别为68%（23/34）、30%（9/30）、38%（10/26）和0（0/2）。鳞状细胞癌的生存率显著高于腺癌（P<0.01）和小细胞癌（P<0.05）。腺癌和小细胞癌之间无显著差异。Ⅰ期、Ⅱ期和Ⅲ期患者的5年生存率分别为63%（19/30）、53%（16/30）和22%（7/32）。Ⅰ期和Ⅱ期之间无显著差异，而Ⅰ期和Ⅲ期之间差异显著（P<0.01），Ⅱ期和Ⅲ期之间差异显著（P<0.05）。接受根治性切除患者的5年生存率为67%（38/57），相对根治性切除患者为14%（4/28），差异有统计学意义（P<0.01）。7例接受非根治性切除的患者术后均未存活超过5年。
青年肺癌患者男性多于女性。鳞状细胞癌占多数，但与腺癌和小细胞癌相比无统计学差异。青年患者的全肺切除率显著高于40岁以上患者。青年患者术后5年生存率显著高于同期40岁以上接受手术的患者。鳞状细胞癌及接受根治性切除的患者预后良好，而Ⅲ期癌症患者预后较差。
