肺非黏液型微小浸润性腺癌309例临床病理及预后分析

目的 探讨肺非黏液型微小浸润性腺癌(minimally invasive adenocarcinoma,MIA)的临床病理学特征及预后.方法 回顾性分析309例肺非黏液型MIA的临床病理学特征,并行CD34和TUBB3免疫组化染色,探讨其在辅助判断早期浸润中的价值.结果 309例肺非黏液型MIA中,男女比为1:2,中位...     

早期肺腺癌中TGF-β1、p53、E-cadherin的表达及其相关性

目的探讨TGF-β1、p53、E-cadherin蛋白在早期肺腺癌中的表达及其相关性。方法采用免疫组化MaxVision法检测16例肺部不典型腺瘤样增生(atypical adenomatous hyperplasia, AAH)、33例原位腺癌、22例微浸润性腺癌、26例附壁生长为主型的浸润性肺腺癌(lepidic predominant adenocarcinoma, LPA)组织中TGF-β1、p53、E-cadherin蛋白的表达,并复习相关文献。结果早期肺腺癌中随着组织病理学分级的增高TGF-β1、p53蛋白阳性率升高,E-cadherin蛋白阳性率降低(P0.05)。在微浸润性腺癌及LPA浸润成分中TGF-β1、p53阳性率高于非浸润成分,E-cadherin阳性率低于非浸润成分(P0.05)。AAH、原位腺癌中TGF-β1与E-cadherin表达呈负相关,微浸润性腺癌和LPA的非浸润成分中TGF-β1与E-cadherin表达呈负相关(P0.05)。结论 TGF-β1、p53、E-cadherin蛋白在早期肺腺癌组织中存在异常表达,检测TGF-β1、p53、E-cadherin蛋白的表达有可能为早期肺腺癌的诊断提供依据。     

肿瘤标志物在肺腺癌诊断中的临床应用

目的 探讨胸水和血清肿瘤标志物在肺腺癌患者诊断中的应用价值。方法 选取本院2016年5月至2021年7月收治的35例肺腺癌伴胸水患者作为肺腺癌组,并选择同期住院的呼吸系统疾病(肺炎、肺感染、慢性阻塞性肺病等)患者35例为对照组,检测两组胸水和血清中肿瘤标志物及生化水平变化。结果 (1)肺腺癌组胸水CEA、CA19-9、CA72-4水平及胸水CEA/血清CEA比值均显著高于对照组(P<0.01);(2)肺腺癌组血清CEA、CA19-9、CA72-4水平显著高于对照组,ADA水平与对照组相比显著降低(P<0.01或P<0.05);(3)肺腺癌组胸水CEA、CA72-4、LDH水平均显著高于血清水平(P<0.01);(4)胸水CEA诊断肺腺癌的灵敏度高于胸水CA19-9、CA724及血清CEA、CA19-9、CA724;胸水CEA、CA72-4和LDH的灵敏度显著高于血清CEA、CA72-4和LDH(P<0.01或P<0.05);(5)胸水CEA的AUC最大,诊断效能最好。结论 胸水和血清肿瘤标志物检测在肺腺癌患者的诊断中有较好的应用价值,且胸水肿瘤标志物...     

D2-40在肺非典型腺瘤样增生及腺癌中的辅助诊断价值

目的 探讨D2-40 在肺的前驱腺体病变[包括非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)和原位腺癌(adenocarcinoma in situ,AIS)]、微浸润性腺癌(mini-mally invasive adenocarcinoma,MIA)及浸润性腺癌中的辅助诊断价值.方法 收集AAH、AIS、MIA及浸润性腺癌组织各20 例,每例肿瘤均有癌旁正常肺组织作为对照,采用免疫组化EnVision两步法检测D2-40 表达,并复习相关文献.结果 D2-40 在所有正常肺组织肺泡上皮中均 100％(80/80)阳性,且呈胞质连续性强着色;在 20 例AAH、AIS和MIA中的阳性率分别为 85％(17/20)、50％(10/20)和 45％(9/20),其着色强度呈微弱～中等,染色模式呈现不连续或不等间隔,其中MIA中浸润性成分阳性率为30％(6/20),贴壁成分阳性率为45％(9/20);20 例浸润性腺癌中仅 1 例微弱着色,阳性率为5％(1/20).统计分析显示,AAH、AIS、MIA中D2-40 表达分别与浸润性腺癌和正常肺组织相比,差异均有统计学意义(P＜0.005);D2-40 在AAH、贴壁形态腺癌、非贴壁形态的浸润性腺癌、正常肺组织中的表达差异亦有统计学意义(P＜0.005).细支气管化生或腺瘤样增生组织不表达D2-40,肺泡上皮反应性增生呈不连续强着色.结论 随着肺泡上皮克隆性增生程度的增加,D2-40 的阳性率逐渐降低,提示D2-40 在肺泡上皮病变的疾病谱系中具有一定的鉴别诊断价值.     

精准医学背景下肺腺癌肿瘤标志物的研究进展

该文基于测序技术和人类基因组计划的不断发展,对医学工作者和生物信息工作者在肺腺癌领域取得的成果进行归纳分析,阐述了肺腺癌标志物的研究进展等。该文首先介绍了传统通过血清检测的肺腺癌标志物的研究进展,梳理了传统标志物从单一检测到联合检测的发展过程。其次介绍了在精准医学背景下,以多组学数据为依据的肺腺癌肿瘤标志物的研究进展。最后对该领域后期工作提出了展望,有利于研究人员准确掌握发展动态,开阔研究思路。     

高分化胎儿型肺腺癌1例

患者女性 ,2 7岁 ,于 2 0 0 0年 7月 9日无明显诱因出现咳嗽 ,咳血丝痰 ,多发生于晨起时 ,量少 ,色鲜红 ,无发热 ,盗汗 ,无胸闷胸痛及无呼吸困难 ,未予诊治。 1周后症状自然缓解 ,Ｘ线检查发现右肺占位性病变 ,进一步ＣＴ检查报告“右肺癌”。肺部ＰＥＴ检查发现右上肺见一个大小约 2ｃｍ× 2ｃｍ ,边界清楚 ,浓聚程度高的肿物 ,ＳＶＶ值为 2 9,报告为“右上肺背部高代谢病灶 ,考虑为恶性肿瘤”。肝脏Ｂ超 ,头颅ＣＴ检查均未见占位性病变 ,为进一步诊治来我院。发病以来精神尚可 ,体重无明显减轻。术中见肿物位于右上肺叶 ,属周围性肿瘤 ,将…     

pT1期肺腺癌间质浸润的分级及预后意义

目的 探讨TNM病理分期T1(pathologic-T1,pT1)期肺腺癌中间质浸润分级的预后意义.方法 选择具有完整临床病理及随访资料结果 的pT1期肺腺癌85例,根据间质浸润在肿瘤中的部位将每例肿瘤中间质浸润的程度分为1-3级,分析各间质浸润级别病例的临床病理特征及预后.结果 间质浸润各级别肿瘤的病例数为1级:17例(20%),2级:12例(14%),3级:56例(66%).临床病理特征:肿瘤大小及淋巴血管侵犯率除1级病例小于3级病例(P值分别为0.005及0.018)外其余各级病例间的差异无统计学意义.淋巴结转移率及病理学分期在1级和2级病例完全相同并低于3级病例(1级与3级P值分别为0.007及0.002;2级与3级P值分别为0.027及0.021).性别、年龄及吸烟史各级病例间的差异无统计学意义.预后:本组病例5年总生存率是63%.1-3级病例的5年生存率分别为100%、83.3%及46.6%,2级与3级病例间的差异有统计学意义(P=0.027),随访期间病死率1-3级病例分别为0、16.7%及42.9%,1级与3级病例间的差异有统计学意义(P=0.001),而与2级病例间的差异无统计学意义.单因素预后分析提示间质浸润分级(P=0.001)、病理学分期(P<0.001)、淋巴血管侵犯(P<0.001)及淋巴结转移(P<0.001)与预后相关.多因素预后分析提示仅病理学分期(P<0.001)为独立预后因素.结论 间质浸润分级是一个与肿瘤预后及其他预后因素均密切相关组织学分级系统,它可作为pT1期肺腺癌预后分类的标准之一.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

pT1期肺腺癌间质浸润的分级及预后意义

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.     

肺腺癌中微乳头结构临床病理及预后意义的探讨

目的探讨肺腺癌中微乳头结构对肿瘤侵袭行为及其对预后的影响。方法选择具有完整临床病理及随访资料结果的肺腺癌91例,将病例分成微乳头结构阳性组（41例）和阴性组（50例）。阳性组按照该成分占肿瘤的多少又分成微乳头结构＋（占肿瘤的1％～10％）,＋＋（占肿瘤的11％～30％）,＋＋＋（超过肿瘤的30％）。结果总的5年生存率是64．8％。临床分期5年生存率分别为Ⅰ期88．9％、Ⅱ期46．2％、Ⅲ期23．8％。不同临床分期病例间的生存率差异有统计学意义（P=0．000）。微乳头结构含量多少与临床分期、肿瘤大小和5年生存率无关,P值分别是0．065、0．358、0．206。而微乳头结构阳性组和阴性组5年生存率分别是：41．5％和84．0％,P=0．000,且淋巴结转移率前者（65．9％）明显高于后者（20．0％）,P=0．000。有无微乳头结构与临床分期和肿瘤大小有关,P值均为0．000,即分期越晚,肿瘤越大,出现此结构的几率越高。而有无微乳头结构与性别、吸烟史无关。同一临床分期中阳性组与阴性组5年生存率分别是：Ⅰ期：78．6％、92．6％（P=0．1548）;Ⅱ期：30．0％,100％（P=0．0598）;Ⅲ期：17．7％,28．6％（P=0．4045）,但差异无统计学意义。结论肺腺癌中微乳头结构成分提示肿瘤高侵袭转移行为,是影响预后的重要因素,该病理形态的出现应提醒临床采取积极治疗措施并密切随访。     

WHO组织学分类和IASLC分级系统对肺浸润性腺癌生物学行为的差异

目的 探讨WHO组织学分类和国际肺癌研究协会(International Association for the Study of Lung Cancer, IASLC)分级系统与肺浸润性腺癌临床病理特征的关系,比较两种分类方法对预测肺浸润性腺癌生物学行为的价值。方法 收集148例手术切除的肺浸润性腺癌标本,根据WHO组织学分类和IASLC分级系统的诊断标准进行分类和分级。ROC曲线分析两种分类方法对肺浸润性腺癌淋巴结转移、脉管侵犯、神经侵犯、胸膜侵犯、气腔内扩散以及pTNM分期的预测价值。结果 根据WHO组织学结构为主的分类：148例肺浸润性腺癌中贴壁型28例、腺泡型101例、乳头型7例、微乳头型2例、实体型10例;以组织学分类对应的病理分级：高分化28例、中分化108例、低分化12例。根据IASLC分级系统进行分类：148例肺浸润性腺癌中高分化26例、中分化56例、低分化66例。WHO组织学分类和IASLC分级系统与患者性别、肿瘤大小、脉管侵犯、淋巴结转移、气腔内扩散、胸膜侵犯和pTNM分期均相关。ROC曲线显示IASLC分级系统对脉管侵犯、淋巴结转移、气腔内扩散、胸膜侵犯的预测效...     

肺浸润性腺癌并发肺弥漫大B细胞淋巴瘤1例

<正>患者女性,56岁,1个月前于外院CT检查发现右肺上叶磨玻璃病变,右肺局限性支气管扩张,右侧叶间胸膜局限性肥厚。为求进一步诊治,遂来我院就诊。患者偶有胸闷,不伴发热、咳嗽、咳痰、咯血。体检：体温正常,无颈部、腋窝、腹股沟淋巴结肿大,双肺听诊呼吸音清,未闻及干湿罗音,血尿常规、肝肾功能正常。