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Received:August 19, 2023 Published Online:January 20, 2024
Received:August 19, 2023 Published Online:January 20, 2024
中文摘要: 目的 总结恶性肺小结节的临床和分子病理学特征，提高对该疾病的认识。
方法 以2018年3月至2021年12月于江苏省中医院心胸外科行肺小结节手术切除治疗且病理证实为恶性的患者为研究对象。回顾性分析其临床资料和手术标本分子病理学特征。
结果 共纳入患者371例，原位癌39例，微浸润腺癌164例，浸润腺癌168例；女性69.8%，男性30.2%，女性占多数；87.6%患者不吸烟；右肺上叶的恶性结节最多（37.5%），其次为左肺下叶（18.6%）。不同病理类型比较，原位癌、微浸润腺癌和浸润腺癌患者的年龄分别为（54.1±10.9）、（52.2±12.6）和（59.1±9.9）岁（F=16.05, P＜0.01），吸烟率分别为10.3%、3.7%和21.4%（χ2=24.31，P＜0.01），瘤体直径中位值分别为0.55、0.60、0.80 cm（H=76.13, P＜0.01），均以浸润腺癌最高，差异均有统计学意义。浸润腺癌表皮生长因子受体（EGFR）的21外显子、肿瘤抑制蛋白p53（TP53）的突变频率高于原位癌和微浸润腺癌（P＜0.05），而人类表皮生长因子受体2（HER2）的外显子20ins、丝裂原活化蛋白激酶（MAP2K1）和丝氨酸/苏氨酸蛋白激酶（BRAF）的突变频率低于原位癌和微浸润腺癌，差异有统计学意义（P＜0.05）。
结论 具有恶性肺结节的患者，可能有下列特性：女性、不吸烟、位于右肺上叶多见。三种病理类型的恶性结节中，年龄、吸烟率、瘤体直径和驱动基因突变频率存在差异。
Abstract:Objective To summarize the clinical and molecular pathological characteristics of malignant pulmonary nodules and improve understanding of the disease.
Methods Patients who underwent surgical resection of small pulmonary nodules in Cardiothoracic Surgery of Jiangsu Province Hospital of Chinese Medicine from March 2018 to December 2021 and were pathologically confirmed to be malignant were taken as the research objects. Retrospective analysis of clinical data and molecular pathological features of surgical specimens was conducted.
Results A total of 371 patients were enrolled, including 39 cases of carcinoma in situ (CIS), 164 cases of microinvasive adenocarcinoma (MIA) and 168 cases were invasive adenocarcinoma (IA); 69.8% were females, 30.2% were males, with a majority of females. 87.6% of patients did not smoke; The upper lobe of the right lung had the most malignant nodules (37.5%), followed by the lower lobe of the left lung (18.6%). In comparison among different pathological types, the ages of CIS, MIA and IA were (54.1±10.9), (52.2±12.6) and (59.1±9.9) years (F=16.05, P＜0.01), the smoking rates were 10.3%, 3.7% and 21.4% (χ2=24.31, P＜0.01), the median tumor diameter was 0.55, 0.60 and 0.80 cm (H=76.13, P＜0.01), respectively, with IA all being the highest, and the differences were statistically significant. The mutation frequency of exons 21 of epidermal growth factor receptor (EGFR), and tumor suppressor protein p53 (TP53) in IA were higher than those in CIS and MIA (P＜0.05), while the mutation frequency of human epidermal growth factor receptor 2 (HER2) exon 20ins, mitogen-activated protein kinase (MAP2K1) and serine/threonine protein kinase (BRAF) were lower than those in CIS and MIA, and the differences were statistically significant (P＜0.05).
Conclusion Patients with malignant pulmonary nodules may have the following characteristics: more common in women, non-smoking, located in the upper lobe of the right lung. There are differences in age, smoking rate, tumor diameter and driving gene mutation frequency among the three pathological types of malignant nodules.
keywords: Small pulmonary nodules, malignant Carcinoma in situ Microinvasive adenocarcinoma Invasive adenocarcinoma Molecular pathological feature
文章编号： 中图分类号：R734.2 文献标志码：A
基金项目:国家自然科学基金（81774081）
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