2771例肺肿瘤临床病理特征分析

目的：根据WHO(2015版)肺肿瘤组织学分类标准，探讨军事医学科学院附属医院肺肿瘤的病理类型及分布特点。方法：收集2010年11月1日至2015年3月31日病理诊断2771例肺肿瘤，复习其临床资料、HE切片及免疫组织化学切片。按WHO(2015版)分类标准进行病理诊断及分类。结果：2771例肺肿瘤中多数为男性1671例(60.30%)，少数为女性1100例(39.70%)；左肺1286例(46.41%)、右肺1456例(52.54%)、双肺29例(1.05%)；年龄16~91岁。腺癌1622例(58.53%)、鳞癌424例(15.30%)、腺鳞癌32例(1.15%)、神经内分泌肿瘤465例(16.78%)、大细胞癌19例(0.69%)、梭形细胞癌1例(0.04%)、巨细胞癌1例(0.04%)、癌肉瘤17例(0.61%)、淋巴上皮样癌1例(0.04%)、唾液腺型肿瘤4例(0.14%)、腺瘤11例(0.40%)、间叶性肿瘤55例(1.98%)、淋巴瘤7例(0.25%)、异位起源性肿瘤13例(0.47%)、转移性肿瘤99例(3.57%)。非小细胞肺癌-非特指型，倾向于腺癌小活检中TTF-1抗体阳性率为92.60%(1263/1364)、NapsinA抗体阳性率为97.07%(1324/1364)；非小细胞肺癌-非特指型，倾向于鳞癌小活检中CK5/6阳性率为96.99%(290/299)、P40阳性率为98.51%(66/67)、P63阳性率为93.72%(343/366)。非小细胞肺癌分子亚型首次活检中EGFR基因突变率34.77%(378/1087)，KRAS基因突变率2.92%(24/823)，BRAF基因突变率0.87%(5/572)，ALK融合基因阳性率11.99%(41/342)，ALK-D5F3抗体阳性率22.23%(66/296)，ROS1融合基因阳性率2.56%(7/273)，c-Met基因扩增率4.40%(12/273)，c-Met基因突变率6.67%(1/15)，Her-2基因突变率0.73%(2/273)，PIK3CA基因突变率13.33%(2/15)，PTEN基因突变率6.67%(1/15)，RET融合基因阳性率0(0/15)和NTRK1融合基因阳性率0(0/15)。二次活检率EGFR基因4.76%(18/378)，ALK融合基因2.44%(1/41)。结论：肺肿瘤在男性患者中高发，病变部位最常见于右肺，腺癌已经成为最常见的病理类型。首次活检中非小细胞肺癌驱动基因中EGFR基因、ALK融合基因存在较高的突变率，其他基因突变率虽低但不容忽视。二次活检率较低，需引起重视。

2 771 cases of clinicopathological analysis of pulmonary neoplasm

Objective:To analyze clinicopathological features and observe the pathological type and distribution among pulmonary neoplasm in Affiliated Hospital of Academy of Military Medical Sciences, according to the World Health Organization criteria (2015).Methods:A retrospective analysis of 2 771 cases of pulmonary neoplasm from November 1st 2010 to March 31th 2015was made by authors. All the histopathological slides including HE slides and immunohistochemistry slides were re-examined and the medical records were reviewed.Results: Among the 2 771 cases, most patients were males (1 671 cases), which accounted for 60.30%, and rare cases were females (1 100 cases), which accounted for 39.70%; the letf lung patients were 1 286 cases, which accounted for 46.41%, the right lung patients were 1 456 cases, which accounted for 52.54%, and the bilateral lung patients were 29 cases, which accounted for 1.05%; ages ranged from 16 to 91. A total of 1 622 cases were adenocarcinoma (58.53%), 424 cases were squamous carcinomas (15.30%), 32 cases were adenosquamous carcinoma (1.15%), 465 cases were neuroendocrine tumors (16.78%), 19 cases were large cell carcinoma(0.69%), 1 case was spindle cell carcinoma (0.04%), 1 case was giant cell carcinoma (0.04%), 17 cases were carcinosarcoma (0.61%), 1 case was lymphoepithelioma-like carcinoma (0.04%), 4 cases were salivary gland-type tumours (0.14%), 11 cases were adenomas (0.40%), 55 cases were mesenchymal tumours (1.98%), 7 cases were lymphoma (0.25%), 13 cases were tumours of ectopic origin (0.47%), 99 cases were metastatic tumours (3.57%). hTe positive rates of TTF-1 and NapsinA antibody were 92.60% (1 263/1 364) and 97.07%(1 324/1 364) in NSCLC-NOS, favor adenocarcinoma small biopsies; the positive rates of CK5/6, P40 and P63 antibody were 96.99% (290/299), 98.51% (66/67) and 93.72% (343/366) in NSCLC-NOS, favor squamous carcinomas small biopsies; among non-small cell lung cancer, 34.77% (378/1087) haveEGFR gene mutations, 2.92% (24/823) haveKRAS gene mutations, 0.87% (5/572) haveBARF gene mutations, 11.99% (41/342) haveALK fusion gene, 22.23% (66/296) have the positive of ALK-D5F3 antibody, 2.56% (7/273) haveROS1 fusion gene, 4.40% (12/273) havec-Met gene ampliifcation, 6.67% (1/15) havec-Met gene mutation, 0.73% (2/273) haveHer-2 gene mutations, 13.33% (2/15) havePIK3CA gene mutations, 6.67% (1/15) havePTEN gene mutation, and none hasRET orNTRK1 fusion gene in primary biopsy. hTe second biopsy rate was 4.76% (18/378) inEGFR gene mutations, and 2.44% (1/41) inALKfusion genes.Conclusion:Male patients have high incidence of lung neoplasms, and the most common lesions were in the right lung. Adenocarcinoma has become the most common pathological type in lung cancer. hTe mutation rate ofEGFR gene andALK fusion gene are high, and other genes are low but they should not be ignored in primary biopsy. We should pay attention to the second biopsy rate which is relatively low.