2 771例肺肿瘤临床病理特征分析
| 作者: |
1许春伟,
1王海艳,
1吴永芳,
1邵云,
1邰艳红,
1李晓兵,
2刘晓晴,
2高红军,
3马群风,
4杨武威,
5吴世凯
1 军事医学科学院附属医院病理科，北京 100071 2 军事医学科学院附属医院肺部肿瘤科，北京 100071 3 军事医学科学院附属医院普胸外科，北京 100071 4 军事医学科学院附属医院肿瘤微创治疗科，北京 100071 5 军事医学科学院附属医院放疗科，北京 100071 |
| 通讯: |
邵云
Email: shysep@163.com 邰艳红 Email: taiyanhong29@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.02.012 |
摘要
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2 771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：2 771例肺肿瘤中多数为男性1 671例(60.30%)，少数为女性1 100例(39.70%)；左肺1 286例(46.41%)、右肺1 456例(52.54%)、双肺29例(1.05%)；年龄16~91岁。腺癌1 622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%(1 263/1 364)、NapsinA抗体阳性率为97.07%(1 324/1 364)；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%(378/1 087)，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。
关键词：
肺肿瘤
肺癌
临床病理
驱动基因
2 771 cases of clinicopathological analysis of pulmonary neoplasm
CorrespondingAuthor: SHAO Yun Email: shysep@163.com
DOI: 10.3978/j.issn.2095-6959.2016.02.012
Abstract
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 2015 was 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 left 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%). The 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) have EGFR gene mutations, 2.92% (24/823) have KRAS gene mutations, 0.87% (5/572) have BRAF gene mutations, 11.99% (41/342) have ALK fusion gene, 22.23% (66/296) have the positive of ALK-D5F3 antibody, 2.56% (7/273) have ROS1 fusion gene, 4.40% (12/273) have c-Met gene amplification, 6.67% (1/15) have c-Met gene mutation, 0.73% (2/273) have Her-2 gene mutations, 13.33% (2/15) have PIK3CA gene mutations, 6.67% (1/15) have PTEN gene mutation, and none has RET or NTRK1 fusion gene in primary biopsy. The second biopsy rate was 4.76% (18/378) in EGFR gene mutations, and 2.44% (1/41) in ALK fusion 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. The mutation rate of EGFR gene and ALK 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.