Gu H T, Zhou J Y, Wu T, Zhou J Y
Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China(Gu Haiting is now working in the Department of Respiratory Medicine, the First People's Hospital of Wenling City, Zhejiang Province).
Zhonghua Yi Xue Za Zhi. 2018 Mar 13;98(10):744-748. doi: 10.3760/cma.j.issn.0376-2491.2018.10.006.
To investigate the clinical features and prognosis of patients with pulmonary sarcomatoid carcinoma (PSC). The study retrospectively reviewed the clinical, radiological, pathological characteristics and prognosis of 76 patients with PSC who were treated in the First Affiliated Hospital of Medical School of Zhejiang University from January 2011 to December 2016. Gender, age, smoking history, tumor location, tumor size, lymph node metastasis, distant metastasis, TNM staging and treatment methods were analyzed to determine the factors affecting the prognosis of PSC patients. The 76 patients with PSC consisted of 61 men and 15 women, the average age was (62.9±9.8) years old. Cough (31 cases, 40.8%), hemoptysis (29 cases, 38.2%) and chest pain (15 cases, 19.7%) were the main clinical manifestations; the average diameter of tumor was (4.7±2.3) cm; the peripheral type (48 cases, 63.2%), right lung (51 cases, 67.1%) and upper lobe of the lung (46 cases, 60.5%) were the common locations. The tumors usually were with a smooth margin, showing an irregular annular enhancement around the area, but the central part of the tumors were not enhanced obviously. The main pathologic type was pleomorphic carcinoma, and immunohistochemistry showed that vimentin and cytokeratin were usually expressed.Tumor size, lymph node metastasis, distant metastasis, TNM staging and early surgical treatment (<0.05) were prognostic factors for survival, and distant metastasis and TNM staging (<0.001) were independent prognostic factors affecting the prognosis of patients. There are no specificity in the clinical and radiological features of PSC patients in our study, and the diagnosis of PSC depends mainly on pathological analysis. Distant metastasis and TNM staging are independent prognostic factors.
探讨肺肉瘤样癌(PSC)患者的临床特征及预后。本研究回顾性分析了2011年1月至2016年12月在浙江大学医学院附属第一医院接受治疗的76例PSC患者的临床、影像学、病理特征及预后。分析患者的性别、年龄、吸烟史、肿瘤位置、肿瘤大小、淋巴结转移、远处转移、TNM分期及治疗方法,以确定影响PSC患者预后的因素。76例PSC患者中,男性61例,女性15例,平均年龄为(62.9±9.8)岁。主要临床表现为咳嗽(31例,40.8%)、咯血(29例,38.2%)和胸痛(15例,19.7%);肿瘤平均直径为(4.7±2.3)cm;常见部位为外周型(48例,63.2%)、右肺(51例,67.1%)和肺上叶(46例,60.5%)。肿瘤边缘通常光滑,周边区域呈不规则环形强化,但肿瘤中央部分强化不明显。主要病理类型为多形性癌,免疫组化显示波形蛋白和细胞角蛋白通常表达。肿瘤大小、淋巴结转移、远处转移、TNM分期及早期手术治疗(<0.05)是生存的预后因素,远处转移和TNM分期(<0.001)是影响患者预后的独立预后因素。本研究中PSC患者的临床和影像学特征无特异性,PSC的诊断主要依赖病理分析。远处转移和TNM分期是独立的预后因素。