【作者】 潘登；

【导师】 王远东；

【作者基本信息】 广州医学院 ， 肿瘤学， 2011， 硕士

【摘要】 研究背景:原发性支气管肺癌,又称为肺癌,是一种来源于支气管黏膜或腺体的恶性肺部肿瘤,是世界上最常见的致命的恶性肿瘤之一,占全部恶性肿瘤的16%,所有癌症死亡的28%。它的发病率最近50年来有明显上升趋势。在过去的10年,全球肺癌的发病率每年以22%的速度飞速上升,每年新增病例达110万,死亡达100万。在全世界范围内,无论男性还是女性,肺癌都已经成为癌症死亡的主要原因。目前我国肺癌发病率在农村占第3位,在城市里占恶性肿瘤的第一位,。1997年以来,肺癌已经在我国的肿瘤死因顺序中居第一位。肺癌中大约有80%为非小细胞肺癌(non-small cell lung cancer,NSCLC)。非小细胞肺癌主要分由肺鳞状细胞癌和肺腺癌组成,以往多以肺鳞癌为主,随着肺癌发病因素的变化以及环境社会等其他因素的变化,肺腺癌已经越来越多的出现在临床的实际病例之中,而且有其特殊的临床特点,不得不引起我们的重视。研究目的分析肺腺癌(adenocarcinoma of lung)的临床特点,病理分期及影响因素。资料和方法对广州医学院附属肿瘤医院自2009年2月至2010年12月连续收治的136例经病诊断为肺腺癌的患者的临床及病例资料进行回顾性分析,然后通过分析的结果,根据病理结果将136例肺腺癌患者分为I期肺癌和其他分期的肺癌两组,用统计学方法进行分析,研究和讨论年龄、性别、吸烟、临床症状、明确诊断的时间等对病理分期的影响,并对其中29例不能手术的肺腺癌患者进行液相芯片技术检测,达到对其个体化治疗的重要参考作用,并结合文献加以讨论。结果本组病例占我院同期肺癌的29.3% (136/464),其中男性35例,女性101例,男女之比为1:2. 89。肺腺癌的影像学表现不复杂,但是不容易与肺炎性病变及其他孤立肺结节病变鉴别,容易造成误诊。如果患者有咳嗽、咳痰或胸闷气短等症状,经正规抗炎或抗结核治疗无效,影像学检查示病灶为位于肺周边、圆形或者椭圆形分叶状肿块,应高度怀疑肺癌,特别是女性患者无吸烟史,高度怀疑是肺腺癌。液相芯片技术检测对于肺腺癌个体化治疗有重要意义,其他因素在肺腺癌中无统计学意义,性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义。结论肺腺癌与吸烟的关系不象其它非小细胞肺癌(non small-cell lung cancer,NSCLC)那样密切,以女性多,不一定有吸烟史,是一种常见的非小细胞肺癌;由于影像学上的变异性容易被误诊,导致耽搁治疗;性别在I期肺腺癌和其他分期肺腺癌患者所占比例的差异上具有统计学意义,女性患者中I期肺腺癌所占比例明显高于男性。肺腺癌的治疗以手术为主;对完全性切除术后的肺腺癌推荐辅助化疗。对于不能手术的肺腺癌患者应用液相芯片技术检测ERCC1、RRM1、TUBB3mRNA的表达水平,根据结果进行“个体化”化疗的,可以提高化疗疗效。更多还原

【Abstract】 BackgroundPrimary bronchus lung cancer, abbreviation lung cancer, is a kind of bronchial mucosa or gland from the malignant tumor, is the one of the most common malignancies in the word, accounting for 16% of all malignant tumor, 28% of all cancer deaths. Its incidence have clear ascendant trend in almost 50 years .In the past 10 years, the risk of lung cancer boost 22% speed in the world every year, 120 million new cases appear each year, about 110 million deaths. In the worldwide, whether male or female, lung cancer have become the main cause of cancer deaths. At present our country lung cancer rates in the city is the first place in malignant tumor, in rural accounted for third place. Since 1996, the cause of death in China has lung cancer tumors in the first draft. About 80 percent of lung cancer is non-small cell lung cancer (non - small, NSCLC) , Non-small cell lung cancer main points by lung squamous cell carcinoma and lung adenocarcinoma, rcomposed mainly by lung squamous cell carcinoma in the past, along with lung cancer in environment factors and social , other factors changes, lung adenocarcinoma have more and more appear in clinical cases, and has its special clinical characteristics, caused our attention. Research purposeAnalysis of lung adenocarcinoma (adenocarcinoma of the clinical characteristics, the company lung staging and influencing factors of pathology.Material and methodTumor hospital of guangzhou medical colleage since February 2009 to December 2010 , 136 patients with disease diagnosed with lung adenocarcinoma, patients for clinical and cases were analyzed retrospectively, based on pathology results . 136 patients with is adenocarcinoma, patients is divided into stage I lung cancer and other staging of lung cancer two groups, with statistical methods, this paper analyzes the age, sex, smoking, clinical symptoms, diagnosis of time on the influence of pathologic stage, in the case,29 lung adenocarcinoma patients who can’t surgery use liquid chip technology testing, reach the indiidual therapy and the important reference. Finally discussed with other document.The resultsThis period of our cases of lung cancer 29.3% (136/464), including male 35 patients, women, men and women than 101 cases for the 1:2. 89. Lung adenocarcinoma of radiological findings is not complicated, but not easy distinguish with pneumonia venereal change and other isolated pulmonary nodules lesions, easy cause the misdiagnosis identification. If patients have a cough, sputum chest distress, via regular short anti-inflammatory symptoms .antitubercular treatment is invalid, imaging examination reealed lesions in the lung, round for around or oval lobulated mass, should be highly suspected lung cancer, and especially women without smoking history, lung adenocarcinoma is highly suspected. Other factors in lung adenocarcinoma in no statistical significance, liquid chip technology test for lung adenocarcinoma is important indiidual therapy, gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences.conclusionLung adenocarcinoma relationed with smoking unlike other non-small cell lung cancer (non small - cancer cell, NSCLC) , the kind of this lung cancer , women is in common, and doesn’t have a smoking history, is a common non-small cell lung cancer; Due to the variation on image, cause delayed treatment by misdiagnosis; Gender in stage I lung adenocarcinoma and other staging patients with lung adenocarcinoma proportion are statistically significant differences, women in patients with stage I lung adenocarcinoma is significantly higher than male proportion. The treatment of lung adenocarcinoma is operation for the Lord; After resection for completeness of lung adenocarcinoma recommend adjuvant chemotherapy. For not surgery patients with lung adenocarcinoma liquid chip technology applicat ERCC1, RRM1, TUBB3mRNA detection expression level, according to the results of the "individual" chemotherapy, can improve chemotherapy curative effect.更多还原