40岁以下青年肺癌的临床特点与外科治疗

背景与目的 分析40岁以下青年肺癌的临床特点及治疗方法.方法 本文分析了1994-2007年间40岁以下肺癌患者41例.结果 41例患者男性28例,女性13例,男女之比为2.2:1,病理类型中腺癌为19例,鳞癌16例,小细胞肺癌5例,大细胞肺癌1例.误诊率为44%,多误诊为肺结核,肺炎,炎性假瘤及结核性胸膜炎等.结论 青年肺癌在病理类型上腺癌多见,故肿瘤生长快,转移率高.手术切除率(73.2%)低,预后差,5年生存率低.早期诊断和尽早根治切除是关键问题.     

非小细胞肺癌根治术后辅助治疗的评价

我院自1960年初至1983年底24年间手术切除并能观察3年以上疗效的非小细胞肺癌患者157例,包括鳞癌84例、腺癌61例、大细胞癌9例和腺鳞癌3例,本文分析鳞癌和腺癌145例根治术后辅助治     

312例ⅢA期非小细胞肺癌的综合治疗

非小细胞肺癌 (ＮＳＣＬＣ)是肺部常见的恶性肿瘤。早期ＮＳＣＬＣ手术治疗效果好 ,中晚期手术治疗效果差 ,而综合治疗对中晚期ＮＳＣＬＣ预后各家报告不一。我院自 1980年 2月至 1998年 12月对经细胞学及组织学确诊的ⅢＡ期非小细胞肺癌 312例采取以手术为主的综合治疗 ,效果满意 ,现报告如下。1　临床资料与方法1.1　一般情况　本组 312例中 ,男 2 2 4例 ,女 88例 ,男女之比是 2 .5∶1,年龄在 30～ 77岁 ,平均 52 .5岁。病理类型 :鳞癌 185例 ( 59.3% ) ,腺癌 95例 ( 30 .4 % ) ,腺鳞癌 15例 ( 4 .8% ) ,大细胞癌 13例 ( 4 .2 % ) ,癌肉瘤…     

周围型小肺癌的外科治疗

1977～1993年间我们共手术治疗各类肺癌587例,其中瘤体直径在2ｃｍ以内的周围型肺癌49例,占同期肺癌手术的84%。现报告如下。一、临床资料本组男性35例,女性14例。年龄44～72岁,平均年龄582岁。腺癌29例,鳞癌9例,腺鳞癌3例,小细胞癌6例,大细胞癌2例。ＰＴＮＭ分期,Ⅰ期(Ｔ1Ｎ0Ｍ0)32例,Ⅱ期(Ｔ1Ｎ1Ｍ0)9例,Ⅲａ期(Ｔ1Ｎ2Ｍ0)8例。病变在右肺32例,左肺17例。49例实行52例次手术,其中1例舌段腺癌袖状切除术后3个月复发,行二次左全肺切除;另有2例腺癌楔形切除后复发行肺叶切除(表1)。表1　病变部位及术式病变部位例数肺叶(或双叶)切除肺段切除…     

非小细胞肺癌组织学分型在不同肿瘤大小亚组中的预后意义

目的:评价非小细胞肺癌组织学分型在手术预后中的地位,以及在肿瘤分期中的应用范围和可行性.方法:回顾性分析1 081例非小细胞肺癌患者术后的预后情况,比较鳞癌和腺癌患者的生存差异,分析肿瘤大小与组织学分型和淋巴结转移之间的相关性.结果:可手术切除非小细胞肺癌肿瘤最大直径≤3 cm的亚组中,腺癌和鳞癌的生存率无明显差异(P＞0.05);而在肿瘤最大直径＞3cm的亚组中,腺癌的生存率明显低于鳞癌(P＜0.05).组织学分型与淋巴结转移无显著相关性(P＜0.05).结论:组织学分型对于特定的非小细胞肺癌患者具有预后预测价值,肿瘤最大直径＞3cm的腺癌患者的预后不如鳞癌患者.肿瘤大小可能具有区分不同组织学分型预后差异的能力.     

青年原发性支气管肺癌的临床特点分析

目的探讨青年原发性支气管肺癌的临床及病理特点。方法对我院2007年1月-2008年12E经病理学证实的40岁以下217例肺癌患者的资料进行回顾性分析。结果青年人肺癌男女比例为1．47：1;咳嗽、胸痛、血痰最为常见,咳嗽占67.3％;腺癌为42．4％;TNM分期以ⅢB、Ⅳ期为主,达70．5％。结论青年人肺癌以腺癌为主,其次为鳞癌和小细胞癌;确诊时多为晚期,预后差。重视青年患者的肺部表现,及时施行必要的检查,有助于肺癌的早期诊断和治疗。     

晚期非小细胞肺癌两种化疗方案的疗效比较

非小细胞肺癌临床上治疗效果欠佳且预后差，由于近来对非小细胞肺癌。治疗研究的进展和新药的临床应用，非小细胞肺癌疗效有所提高。我院自1995年5月一19M年5月，收住病人中用MVP方案治疗非小细胞肺癌26例，同期住院病人用CAP方案治疗32例非小细胞肺癌作对比观察，现将结果分析如下。临床资料1．一般资料两组共58例非小细胞肺癌，均经组织学或细胞学检查证实。MVP组：男24例，女2例。年龄39－74岁，平均61．2岁。其中鳞癌6例，腺癌15例，腺鳞癌3例，大细胞未分化癌2例。CAf，组：男25例，女7例，年龄25－75岁，平均54．l岁，其中腺癌20…     

179例N2期非小细胞肺癌外科治疗体会

肺癌淋巴结转移是影响患者预后的重要因素,纵隔淋巴结转移(N2)曾被认为预后不佳。近年来文献报道选择性N2肺癌外科治疗获得了较好的长期生存效果［1～3］。本文总结了179例N2期非小细胞肺癌（non-small cell lung cancer,NSCLC）手术治疗体会,并就肺癌手术淋巴结清除必要性和影响N2非小细胞肺癌预后的相关因素进行讨论。 1 资料和方法 1987年1月～1996年12月间我院施行了肺癌切除手术573例,179例术后病理诊断为N2期非小细胞肺癌。其中男性141例,女性38例;年龄34～79岁,平均58.2岁;中心型肺癌84例,周围型肺癌95例;鳞癌101例,腺癌53例,大细胞癌4例,鳞腺混合型癌21例。按肺癌国际分期［4］：T1N210例（5.6％）,T2N2 108例(60.3％),T3N2 45例(25.1％),T4N216例（8.9％）。     

周边型小肺癌的几个临床问题

我科共手术治疗原发性肺癌587例，包括周围型小肺癌49例。其中腺癌29例，鳞癌9例，腺鳞癌3例．大细胞癌2例，未分化小细胞癌6例。pTNM分期。Ⅰ期(T1N0M0)32例。Ⅱ期(T1N1M0)9例。ⅢA期(T1N2M2)8例。共实行52术次，(3例Ⅰ期腺癌术后复发二次手术)。结果鳞癌的5年生存率优于腺癌和其他组织类型肺癌；同组织类型小肺癌比较，N0优于N1，N1优于N2。既便是早期小肺癌。尤其是腺癌。预后也不全令人乐观。初步研究结果提示，小肺癌并不全是早期肺癌。术后的综合治疗仍是不可缺少的。     

非小细胞肺癌、食管癌P-gp的检测以及临床相关性研究

目的　观察P -gp在判断非小细胞肺癌及食管癌患者预后方面的价值 ,为临床综合治疗提供更加可靠的依据。方法　以我院手术治疗的 34例非小细胞肺癌 ,81例食管癌患者为研究对象 ,用免疫组化法检测肿瘤标本的P -gp表达 ,将结果与各自的临床资料相结合 ,判断P -gp与肿瘤病理类型、有无淋巴结转移及预后之间的关系。结果　①非小细胞肺癌中P -gp在腺癌中表达高于鳞癌 (P <0 .0 5 ) ;P -gp在有淋巴结转移的病例中高表达 (P <0 .0 5 ) ;P -gp阴性表达的患者术后平均生存时间大于阳性表达病例 (P <0 .0 5 ) ,P -gp阳性者预后差。②食管癌中P -gp的表达在腺癌与鳞癌无显著性差异 (P >0 .0 5 ) ;有无淋巴结转移无显著性差异 (P >0 .0 5 ) ;P -gp阳性患者术后平均生存时间少于阴性患者 (P <0 .0 5 ) ,P -gp阳性者预后差。结论　非小细胞肺癌及食管癌癌组织中P -gp的表达与预后明显相关     

The elderly with synchronous non-small cell lung cancer and solitary brain metastasis: does palliative thoracic radiotherapy have a useful role?

We evaluated the prognosis associated with advanced age by comparing the clinical features of individuals 65 years of age and older to those of younger patients with single metastasis to the brain alone (SMBA) and simultaneous non-small cell lung cancer (NSCLC), and the potential role of palliative thoracic radiotherapy in this cohort of patients. Our 23-year experience included 72 consecutive (22 elderly and 50 non-elderly) people. Older patients predominantly presented with N0-N1 stage disease and coexisting illness. Univariate analysis showed that younger age (p=0.04) and operative removal of SMBA (p=0.01) were predictive of better survival. However, with multivariate analysis, resection of SMBA remained the sole predictor of prognosis. The application of NSCLC radiotherapy for palliation did not favorably alter outcome. In conclusion, elderly patients with simultaneous NSCLC and SMBA seem to fare less well than their younger counterparts. Moreover, the concurrent application of radiotherapy for palliation of the lung neoplasm was not prognostically advantageous.     

老年原发性非小细胞性肺癌临床特征

[目的]明确老年原发性非小细胞性肺癌临床及肿瘤生物学特征,为其早期诊断和治疗提供理论指导。[方法]分析安徽医科大学第一附属医院1996年至1998年3年间经病理或(和)细胞学确诊的原发性非小细胞性肺癌病例,将其中大于70岁(老年组)和小于40岁(青年组)作为研究对象,按照临床症状、组织学类型、临床分期、治疗方式和生存率等跟踪随访3年并将相关资料进行统计分析。[结果]在3年间确诊为原发性非小细胞性肺癌病例中,老年组148例,青年组104例。老年组以男性为主,青年组以女性为主,差异分别具有显著性(P<0.05);老年组鳞癌多见,青年组腺癌多见,差异分别具有显著性(P<0.05);老年组多采用以支持和化疗为主的综合治疗,青年组采用以手术为主的综合治疗方案;老年组3年累计生存率为17.5%,中位生存数为14个月;青年组3年累计生存率是28.6%,其中位生存数为18.2个月,差异具有显著性(P=0.018)。[结论]老年原发性非小细胞性肺癌患者主要是男性和鳞癌;老年组的总的生存率和预后较青年组差。     

Lung cancer in patients younger than 40 years of age.

BACKGROUND AND OBJECTIVES: We investigated whether the clinicopathologic characteristics and prognosis of lung cancer in younger patients differ from those of older patients. METHODS: Among 2,763 lung cancer patients treated during the period from April of 1972 to April of 1997, we retrospectively investigated the clinical features and prognosis of 53 patients under 40 years of age (young group) and compared them with the findings of 1,886 patients with 60 years of age or older (elderly group). RESULTS: The proportion of female patients in the younger group was significantly higher than that in the elderly group (39.6% vs. 24.1%). The young group had a significantly higher proportion of adenocarcinoma (75.5% vs. 44.8%) and stage III-IV disease (73.6% vs. 59.2%) and a significantly lower proportion of squamous cell carcinoma (3.8% vs. 32.1%). Regarding the selection of therapy, in the young group, a significantly lower proportion of patients underwent surgical therapy (35.8% vs. 41.5%) and a significantly higher proportion of those (37.7% vs. 16.4%) received chemotherapy. The overall survival between the young and elderly groups was not significantly different. Moreover, the 5-year survival rate of the patients undergoing a surgical resection was 56.1% in the young group and 44.8% in the elderly group (P = 0.0615). CONCLUSIONS: This study suggests that the prognosis of young patients with lung cancer is at least equivalent to that of older patients; therefore, they should be managed according to the general therapeutic guidelines.     

肺鳞癌的个体化治疗进展

鳞状细胞肺癌(SqCLC)是非小细胞肺癌(non-small cell lung cancer，NSCLC)的一种独特的组织学亚型，尤其是晚期鳞癌，由于其特殊的临床病理特征，相对于肺腺癌可选择的治疗药物少，不良反应也大，因此肺鳞癌预后比肺腺癌差。近年来，随着化疗药物的改进，靶向药物的研发，尤其是免疫治疗的重大突破，治疗肺鳞癌有了更多的选择，肺鳞癌也走向了个体化治疗。     

多原发癌中非小细胞肺癌27例的治疗探讨

目的：探讨多原发癌中的肺癌的诊断,治疗及预后。方法：2000年1月至2004年12月,共收治肺癌患者754例。对其临床资料进行了回顾性的分析。根据Warran和Gates提出的多原发癌的诊断标准,筛选出了27例多原发癌中的非小细胞肺癌（NSCLC）,并对其诊断、治疗及予后进行了总结。结果：27例患者中同时性者4例,异时性者23例。本组27例总的手术切除率为77.8%（21/27）,根治术为59.0%（16/27）,根治性术者1年生存率为80.0%,3年生存率为46.7%;姑息术者1年生存率为33.0%,3年生存率为11.0%。结论：有恶性肿瘤手术史者,特别是无瘤生存期超过两年者,当肺内出现孤立结节,或者无肿瘤病史者肺内不同肺叶,同时或异时出现孤立结节,纵隔及全身无转移癌者,要考虑到多原发癌中的肺癌的可能,应与肺转移癌鉴别,一旦确诊为原发肺癌,争取行根治术,以获取较好预后。     

30岁以下青年人肺癌：附135例X线分析

In 9,256 patients with primary lung cancer admitted to our hospital in the past 30 years (1958-1987), 161 patients (1.73%) were under 30 years. All were proved by pathology or cytology. In the recent 5 years (1983-1987), the incidence of lung cancer in the youth was 29.5% of the total young lung cancer patients, though the ratio of young to the total in different periods remained unchanged. Histologically, small cell lung carcinoma ranked first (45.6%). Thirty-six percent of the patients had a history of mild smoking. The radiographic features were analysed in 135/161 patients who were examined by X-ray before treatment in our hospital. Differential diagnosis and causes of misdiagnosis are briefly discussed. The key of improving the accuracy of diagnosis is to keep vigilance against lung cancer in the young patients.     

女性肺癌的临床特点

 本文报道我院1978年1月～1992年7月间经外科治疗、病理证实的女性肺癌210例,占同期收治肺癌的20.8%,男女比例为3.8:1.女性肺癌有其明显的临床特点:1.发病年龄低于男性,年龄越小女性肺癌比例越大,<30岁者女性占43.5%(10/23);2.肺癌的组织类型中,女性腺癌发生率最高达44.8%,鳞癌占22.4%,与男性肺癌相比较其腺癌、类癌及其他低恶性肿瘤发生率较高(P<0.01),无大细胞癌;3.女性肺癌切除率为77.1%,低于男性,手术死亡率4.3%,高于男性;4.切除术后1、3、5年生存率为74.1%,39.3%及34.4%,均高于男性.预后较好可能与女性腺癌细胞浆中雌激素激体有关,其性别可作为估计预后的一个因素.     

A retrospective analysis comparing patients 70 years or older to patients younger than 70 years with non-small-cell lung cancer treated with surgery at Indiana university: 1989-1999

Surgery remains the cornerstone of therapy for medically operable patients with early-stage non-small-cell lung cancer (NSCLC). However, there are few reports on the short-term morbidity and long-term survival following surgery in elderly patients with NSCLC. The surgical experience in 280 patients with NSCLC at Indiana University from 1989-1999 are reported with a comparison of patients who are >or= 70 years versus < 70 years of age. Preoperative characteristics, operative procedures, postoperative courses, and survival were compared between the age groups. Fifty percent of elderly patients had squamous cell carcinoma and 36.2% had adenocarcinoma, versus 41.3% and 44.4% in younger patients, respectively. In both groups, most patients had T1 or T2 tumors and N0 disease. The majority of patients in both age groups had a lobectomy. However, more patients younger than 70 years had chest wall resections and were more likely to undergo a pneumonectomy (19.5% vs. 6.9%). The median number of postoperative hospital days was shorter for younger patients (9 days vs. 11 days). Overall, more complications occurred in older patients, but no significant difference in cardiac or pulmonary complications was observed between the groups. There was no significant difference in survival between the age groups. This single-institution series demonstrates that surgical intervention for appropriately selected elderly patients with NSCLC results in similar complication rates and long-term survival when compared to their younger counterparts.     

Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients

Fifty-seven patients treated by radical gastric resections were retrospectively studied to understand the clinicopathologic characteristics of advanced gastric cancer without serosal invasion (the depth of tumor invasion limited to the muscularis propria or subserosal layer) in young and old age persons. There were 36 patients in the old age group (age > 60 years) and 21 in the young age group (age ≤ 40 years). The clinical and pathologic parameters for this study included sex, gross type, location, maximum tumor size, depth of invasion, lymph node metastasis, tumor stage, histologic type, and rate of curative resection. The old patients had a higher percentage of small tumors, subserosal invasion and lymph node metastasis, but these parameters were not significantly different from those of the young patients, nor did the sex ratio, gross type, location, and rate of curative resection show significant differences. The histologic feature was the only statistically significant parameter, determined by univariate and multivariate analyses. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were detected in 10 (47.6%) and 4 (19.0%) of the 21 younger patients, respectively, while there were 4 (11.1%) and 2 (5.6%) in the old age group. Although the gastric cancer in young patients had more aggressive histologic characteristics than it did in elderly patients, survival rates between the two groups did not differ to any great degree. Our findings indicate that the prognosis for younger patients with advanced gastric cancer without serosal invasion was favorable when curative resection was performed. © 1996 Wiley-Liss, Inc.