Fishback N F, Travis W D, Moran C A, Guinee D G, McCarthy W F, Koss M N
Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000.
Cancer. 1994 Jun 15;73(12):2936-45. doi: 10.1002/1097-0142(19940615)73:12<2936::aid-cncr2820731210>3.0.co;2-u.
The authors undertook this study to define the clinical and histologic characteristics of spindle and giant cell carcinomas of the lung and the survival and prognostic features of these tumors.
Seventy-eight cases of pleomorphic (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy and immunohistochemistry to establish clinical, gross, and histologic parameters. Follow-up information was obtained from contributing physicians and analyzed by statistical means to determine prognostically significant parameters.
The patient population consisted of 57 men and 21 women (male to female ratio, 2.7 to 1) between the ages of 35 and 83 years (mean, 62 years). Clinically, 58 patients (80%) presented with symptoms including thoracic pain, cough, and hemoptysis, whereas 14 (18%) were asymptomatic. At the time of diagnosis, 41% of the patients had clinical Stage I lesions, 6% Stage II lesions, 39% Stage III lesions, and 12% Stage IV lesions. Histologically, foci of squamous cell carcinoma were present in 8% of the tumors, large cell carcinoma in 25%, and adenocarcinoma in 45%. The remaining 22% of neoplasms were completely spindle and/or giant cell carcinomas. Spindle and giant cell carcinomas were found together in 38% of the patients. In the 69 patients for whom follow-up information was obtained, 53 (77%) died within 7 days to 6 years after diagnosis, with a 23-month mean survival (median, 10 months) (Kaplan-Meier method). There was a significant shortening of survival for patients with tumor size greater than 5 cm, clinical stage greater than 1, and lymph node involvement. The presence of nodal metastases was the most significant single prognostic factor, whereas the presence of squamous or adenocarcinomatous differentiation did not have an impact on length of survival.
The frequency with which spindle and giant cell carcinomas are found together, their frequent association with other histologic subtypes of lung carcinoma, and the similar clinicopathologic features of these tumors suggest that they are best regarded as one type of lung cancer called pleomorphic carcinoma.
作者开展本研究以明确肺梭形细胞癌和巨细胞癌的临床及组织学特征，以及这些肿瘤的生存和预后特征。
对78例肺多形性（梭形和/或巨细胞）癌进行光镜和免疫组化研究，以确立临床、大体和组织学参数。从参与研究的医生处获取随访信息，并通过统计学方法进行分析，以确定具有预后意义的参数。
患者群体包括57名男性和21名女性（男女比例为2.7比1），年龄在35至83岁之间（平均62岁）。临床上，58例患者（80%）出现胸痛、咳嗽和咯血等症状，而14例（18%）无症状。诊断时，41%的患者为临床I期病变，6%为II期病变，39%为III期病变，12%为IV期病变。组织学上，8%的肿瘤有鳞状细胞癌灶，25%有大细胞癌灶，45%有腺癌灶。其余22%的肿瘤为完全性梭形和/或巨细胞癌。38%的患者同时存在梭形细胞癌和巨细胞癌。在获得随访信息的69例患者中，53例（77%）在诊断后7天至6年内死亡，平均生存时间为23个月（中位数为10个月）（Kaplan-Meier法）。肿瘤大小大于5 cm、临床分期大于1期以及有淋巴结受累的患者生存时间显著缩短。存在淋巴结转移是最显著的单一预后因素，而鳞状或腺癌分化的存在对生存时间没有影响。
梭形细胞癌和巨细胞癌同时出现的频率、它们与肺癌其他组织学亚型的频繁关联以及这些肿瘤相似的临床病理特征表明，它们最好被视为一种称为多形性癌的肺癌类型。
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