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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。
Objective To investigate the effect of micro-nipple structure on tumor invasion and its prognosis in lung adenocarcinoma. Methods 91 cases of lung adenocarcinoma with complete clinical pathology and follow-up data were selected. The cases were divided into micro-papillary positive group (41 cases) and negative group (50 cases). Positive group according to the composition of the tumor is divided into micro-nipple structure + (1% to 10% of the tumor), ++ (11% to 30% of the tumor), +++ (more than 30% of the tumor). Results The overall 5-year survival rate was 64.8%. The 5-year survival rates of clinical stage were 88.9% in stage Ⅰ, 46.2% in stage Ⅱ, and 23.8% in stage Ⅲ. There were significant differences in survival between different clinical staging cases (P = 0.000). The number of micro-nipple structure and clinical stage, tumor size and 5-year survival rate has nothing to do, P values were 0.065,0.358,0.206. The 5-year survival rates of positive and negative group were 41.5% and 84.0% respectively, P = 0.000, and the former (65.9%) was significantly higher than the latter (20.0%), P = 0.000. The presence or absence of micro-nipple structure and clinical stage and tumor size, P values were 0.000, that is, the later stages, the greater the tumor, the higher the probability of this structure. Whether the micro-nipple structure and gender, smoking history has nothing to do. The 5-year survival rates of the positive and negative groups in the same clinical stage were as follows: stage Ⅰ: 78.6%, 92.6% (P = 0.1548); stage Ⅱ: 30.0%, 100% (P = 28.6% (P = 0.4045), but the difference was not statistically significant. Conclusion The components of micro-papilla in lung adenocarcinoma suggest the high invasion and metastasis of tumor, which is an important factor affecting the prognosis. The occurrence of this pathological form should remind the clinic to take aggressive treatment and follow up closely.