12例支气管腺样囊性癌临床特征及治疗预后分析
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摘要
目的分析12例支气管腺样囊性癌患者的临床特征、治疗方式及预后情况以提高临床诊治水平。方法选择2012年2月至2018年2月唐都医院呼吸科确诊并治疗随访的12例支气管腺样囊性癌患者,收集分析其临床特征及治疗方法,随访生存信息情况。结果 12例患者中位年龄53.5岁,女11例,男1例;均无吸烟史,6例既往无任何疾病史;主要症状咳嗽、咳痰、气短,部分有咯血、胸痛; 8例发病于主气管中下段,主气管上段2例,右中间段支气管1例,左主支气管1例;胸部CT以结节、占位为主,部分见钙化、肉芽;支气管镜下表现为菜花样、结节样、肉芽样及球形新生物;气促指数2级5例,3级3例,4级4例; 1例右肺全切,11例行2种以上的支气管镜下介入治疗,Ⅰ级缓解率、临床有效率、临床受益率均100%; 3例无基线及复发转移,余9例以肺、骨转移多见;生存期均大于5个月。结论气管腺样囊性癌是一种低度恶性、好发于气管中下段、临床易出现气短症状的肿瘤,以肺、骨转移多见,支气管镜可明确病变范围及气道阻塞程度,支气管镜下介入治疗是非手术患者的一种有效选择,生存时间长。
Objective To analyze the clinical features,treatment,and prognosis of 12 cases of bronchial adenoid cystic carcinoma. Methods We collected the clinical features and therapeutic regimens of 12 patients (11 females and 1 male,with the median age of 53. 5 years),who were definitely diagnosed as bronchial adenoid cystic carcinoma and treated in the Respiratory Department in our hospital and carefully followed for their survival information from February 2012 to February 2018. A retrospective analysis was then performed with the clinical features,treatment,and prognosis information. Results All the 12 cases had no history of smoking,and 6 of them had no history of any illness. The main symptoms of all the 12 cases were cough,expectoration,and shortness of breath,and some of them had hemoptysis,chest pain or some other symptoms of respiratory system. In 8 cases,cancer arose from the middle-to-lower bronchial segments and in 2 cases,cancer arose from the upper segment of the main trachea (one from the right middle segment of the bronchus and the other one from the left main bronchus). Chest computed tomography (CT) was performed as a reference for primary diagnosis. In the 12 cases,nodules or masses were mainly shown on CT images,and calcification or granulation could also be observed in the tomography images of some cases. Under a bronchoscope,the tumor tissues were manifested as cauliflower-like,nodule-like,granulation-like,globe-like or other-shaped neoplasms. Borg index reached GradeⅡ in 5 cases,Grade Ⅲ in 3 cases,and Grade Ⅳ in 4 cases. Pneumonectomy was performed in the right lungs in one case and the other 11 cases accepted more than two kinds of bronchoscopic interventional therapies. The remission rate at level 1,clinical efficacy,and clinical benefit rate were all calculated as 100%. No baseline or recurrent metastasis was found in 3 cases,and in the other 9 cases,the carcinomas mainly metastasized to the lungs and bones. The survival time of 12 cases was all longer than 5 months. Conclusion Bronchial adenoid cystic carcinoma is a kind of low-grade malignant tumor,which mainly arises from the middle-to-lower bronchial segments. And the bronchial adenoid cystic carcinoma commonly metastasizes to the lungs and bones. The patients with bronchial adenoid cystic carcinoma are most likely to manifest as shortness of breath. Bronchoscopy can be used to define the extent of disease and obstructive degrees. Interventional therapy under a bronchoscope is an effective option,which can prognose a longer lifetime for nonoperative patients.
Objective To analyze the clinical features,treatment,and prognosis of 12 cases of bronchial adenoid cystic carcinoma. Methods We collected the clinical features and therapeutic regimens of 12 patients (11 females and 1 male,with the median age of 53. 5 years),who were definitely diagnosed as bronchial adenoid cystic carcinoma and treated in the Respiratory Department in our hospital and carefully followed for their survival information from February 2012 to February 2018. A retrospective analysis was then performed with the clinical features,treatment,and prognosis information. Results All the 12 cases had no history of smoking,and 6 of them had no history of any illness. The main symptoms of all the 12 cases were cough,expectoration,and shortness of breath,and some of them had hemoptysis,chest pain or some other symptoms of respiratory system. In 8 cases,cancer arose from the middle-to-lower bronchial segments and in 2 cases,cancer arose from the upper segment of the main trachea (one from the right middle segment of the bronchus and the other one from the left main bronchus). Chest computed tomography (CT) was performed as a reference for primary diagnosis. In the 12 cases,nodules or masses were mainly shown on CT images,and calcification or granulation could also be observed in the tomography images of some cases. Under a bronchoscope,the tumor tissues were manifested as cauliflower-like,nodule-like,granulation-like,globe-like or other-shaped neoplasms. Borg index reached GradeⅡ in 5 cases,Grade Ⅲ in 3 cases,and Grade Ⅳ in 4 cases. Pneumonectomy was performed in the right lungs in one case and the other 11 cases accepted more than two kinds of bronchoscopic interventional therapies. The remission rate at level 1,clinical efficacy,and clinical benefit rate were all calculated as 100%. No baseline or recurrent metastasis was found in 3 cases,and in the other 9 cases,the carcinomas mainly metastasized to the lungs and bones. The survival time of 12 cases was all longer than 5 months. Conclusion Bronchial adenoid cystic carcinoma is a kind of low-grade malignant tumor,which mainly arises from the middle-to-lower bronchial segments. And the bronchial adenoid cystic carcinoma commonly metastasizes to the lungs and bones. The patients with bronchial adenoid cystic carcinoma are most likely to manifest as shortness of breath. Bronchoscopy can be used to define the extent of disease and obstructive degrees. Interventional therapy under a bronchoscope is an effective option,which can prognose a longer lifetime for nonoperative patients.
引文
1杨朝晖,王建军,何燕,等.肺原发性腺样囊性癌的临床病理特征分析[J].中国全科医学,2015,18(24):2961.
2李红林,方进,邓达标,等.支气管黏液表皮样癌[J].中国医学影像技术,2016,32(9):1469.
3冯文华,张冠军,高宇明,等.气管、支气管腺样囊性癌11例临床病理分析并文献复习[J].中国现代医药杂志,2016,18(5):43-47.
4 Scherl S,Alon EE,Karle WE,et al.Rare tracheal tumours and lesions initially diagnosed as isolated differentiated thyroid cancers[J].Thyroid,2013,23(1):79-83.
5路明,王敏,朱翔,等.哮喘样表现的支气管腺样囊性癌1例[J].北京大学学报(医学版),2018,50(2):378-380.
6杨海堂,姚烽,谵台冀,等.气管腺样囊性癌的临床治疗经验分析[J/CD].中华胸部外科电子杂志,2015,2(3):168-173.
7马升军,黄海东,王琴,等.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值[J].四川医学,2016,37(2):196-198.
8王颖.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值分析[J].中国医药指南,2018,16(10):161-162.
9第伍丹琲,王虹,万毅新.气管腺样囊性癌1例并文献复习[J].临床肺科杂志,2017,22(5):959-960.
10李会颖,杨觅,胡静,等.气管腺样囊性癌4例报告[J].临床肺科杂志,2016,21(3):574-576.
11李建民,刘志光,吴怀球,等.经支气管镜治疗气管腺样囊性癌7例[J].湖南师范大学学报,2016,13(5):1-4.
12 Nouraei SM,MIddleton SE,Nouraei SA,et al.Management and prognosis of primary tracheal cancer:Anational analysis[J].Laryngos cope,2014,124(1):145-150.
13 Urdaneta AI,Yu JB,Wilson LD.Population based cancer registry anlysis of primary tracheal carcinoma[J].Am J Clin Oncol,2011,34(1):32-37.
14张兵林,林洁,笪冀平.甲状腺转录因子1、胃酶样天冬氨酸蛋白酶及Ki-67在肺原发唾液腺型癌中的鉴别诊断价值[J].中华病理学杂志,2015,44(7):499-503.
15孟晓燕,叶兆祥,李绪斌,等.气管支气管树腺样囊性癌MSCT表现[J].中国肿瘤临床,2014,41(5):328-331.
16 Wang H,Zhang J,Zhang N,et al.Bronchoscopic intervention as a main treatment for tracheobronchial adenoid cystic carcinoma[J].Minim Invasive Ther Allied Technol,2015,24(3):167-174.
17连成,任梦薇,任立参,等.气管腺样囊性癌8例报告并文献复习[J].中国实验诊断学,2016,20(2):317-319.
18 Zhu F,Liu Z,Hou Y,et al.Primary salivary glandtype lung cancer:clinicopathological analysis of 88 cases from China[J].J Thorac Oncol,2013,8(12):1578-1584.
19 Calzada AP,Miller M,Lai CK,et al.Adenoid cystic carcinoma of the airway:a 30-year review at one institution[J].Am JOtolaryngol,2012,33(2):226-231.
20 Li W,Hua W,Yan FG,et al.Adenoid cystic carcinoma of tracheal:a case report and review of literature[J].Chin Med J(Engl),2012,125(12):2238-2239.
21 Binesh F,Akhavan A,Masumi O,et al.Cliniopathological review and survival characteristics of adenoid cystic carcinoma[J].Indian JOtolaryngol Head Neck Surg,2015,67(suppl 1):62-66.
22阿不都黑力力·麦麦提依明,徐坚民,杨忠,等.气管支气管腺样囊性癌的CT诊断[J].医学影像学杂志,2016,26(6):1022-1025.
23陈松平.支气管腺样囊性癌的多层螺旋CT表现与病理对照分析[J].全科医学临床与教育,2017,15(4):451-453.
24 Jensen AD,Poulakis M,Nikoghosyan AV,et al.High-LET radiotherapy for adenoid cystic carcinoma of the head and neck:15years apos,experience with raster-scanned carbon ion therapy[J].Radiother Oncol,2015,118(2):272-280.
25李亚楠,周云芝,张楠,等.25例晚期原发性气管支气管镜介入治疗临床分析[J].临床肺科杂志,2015,20(4):619-622.
26陈龙,黄海东,董宇超,等.支气管镜介入在甲状腺癌侵犯气管治疗中的应用[J].中国呼吸与危重症杂志,2016,15(3):266-270.
27朱强,岳岩,朱立成,等.氩等离子体凝固术治疗气管腺样囊性癌19例效果分析[J/CD].中华腔镜外科杂志:电子版,2018,11(4):228-233.
28王洪武,金发光,柯明耀.支气管镜介入治疗[M].北京:人民卫生出版社,2012:46-47,100-101.
29 Sherani K,Vakil A,Dodhia C,et al.Maligant tracheal tumous:a review of current diagnostic and management strategies[J].Curr Opin Pulm,2015,21(4):322-326.
30陶梅梅,王洪武,周云芝,等.支气管镜下不同方式治疗气管腺样囊性癌的疗效比较[J].国际呼吸杂志,2013,33:911-914.
31 Zhao Y,Zhao H,Fan L,et al.Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart[J].Ann Thorac Surg,2013,96(6):1998-2004.
2李红林,方进,邓达标,等.支气管黏液表皮样癌[J].中国医学影像技术,2016,32(9):1469.
3冯文华,张冠军,高宇明,等.气管、支气管腺样囊性癌11例临床病理分析并文献复习[J].中国现代医药杂志,2016,18(5):43-47.
4 Scherl S,Alon EE,Karle WE,et al.Rare tracheal tumours and lesions initially diagnosed as isolated differentiated thyroid cancers[J].Thyroid,2013,23(1):79-83.
5路明,王敏,朱翔,等.哮喘样表现的支气管腺样囊性癌1例[J].北京大学学报(医学版),2018,50(2):378-380.
6杨海堂,姚烽,谵台冀,等.气管腺样囊性癌的临床治疗经验分析[J/CD].中华胸部外科电子杂志,2015,2(3):168-173.
7马升军,黄海东,王琴,等.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值[J].四川医学,2016,37(2):196-198.
8王颖.经支气管镜介入技术在气管腺样囊性癌治疗中的临床价值分析[J].中国医药指南,2018,16(10):161-162.
9第伍丹琲,王虹,万毅新.气管腺样囊性癌1例并文献复习[J].临床肺科杂志,2017,22(5):959-960.
10李会颖,杨觅,胡静,等.气管腺样囊性癌4例报告[J].临床肺科杂志,2016,21(3):574-576.
11李建民,刘志光,吴怀球,等.经支气管镜治疗气管腺样囊性癌7例[J].湖南师范大学学报,2016,13(5):1-4.
12 Nouraei SM,MIddleton SE,Nouraei SA,et al.Management and prognosis of primary tracheal cancer:Anational analysis[J].Laryngos cope,2014,124(1):145-150.
13 Urdaneta AI,Yu JB,Wilson LD.Population based cancer registry anlysis of primary tracheal carcinoma[J].Am J Clin Oncol,2011,34(1):32-37.
14张兵林,林洁,笪冀平.甲状腺转录因子1、胃酶样天冬氨酸蛋白酶及Ki-67在肺原发唾液腺型癌中的鉴别诊断价值[J].中华病理学杂志,2015,44(7):499-503.
15孟晓燕,叶兆祥,李绪斌,等.气管支气管树腺样囊性癌MSCT表现[J].中国肿瘤临床,2014,41(5):328-331.
16 Wang H,Zhang J,Zhang N,et al.Bronchoscopic intervention as a main treatment for tracheobronchial adenoid cystic carcinoma[J].Minim Invasive Ther Allied Technol,2015,24(3):167-174.
17连成,任梦薇,任立参,等.气管腺样囊性癌8例报告并文献复习[J].中国实验诊断学,2016,20(2):317-319.
18 Zhu F,Liu Z,Hou Y,et al.Primary salivary glandtype lung cancer:clinicopathological analysis of 88 cases from China[J].J Thorac Oncol,2013,8(12):1578-1584.
19 Calzada AP,Miller M,Lai CK,et al.Adenoid cystic carcinoma of the airway:a 30-year review at one institution[J].Am JOtolaryngol,2012,33(2):226-231.
20 Li W,Hua W,Yan FG,et al.Adenoid cystic carcinoma of tracheal:a case report and review of literature[J].Chin Med J(Engl),2012,125(12):2238-2239.
21 Binesh F,Akhavan A,Masumi O,et al.Cliniopathological review and survival characteristics of adenoid cystic carcinoma[J].Indian JOtolaryngol Head Neck Surg,2015,67(suppl 1):62-66.
22阿不都黑力力·麦麦提依明,徐坚民,杨忠,等.气管支气管腺样囊性癌的CT诊断[J].医学影像学杂志,2016,26(6):1022-1025.
23陈松平.支气管腺样囊性癌的多层螺旋CT表现与病理对照分析[J].全科医学临床与教育,2017,15(4):451-453.
24 Jensen AD,Poulakis M,Nikoghosyan AV,et al.High-LET radiotherapy for adenoid cystic carcinoma of the head and neck:15years apos,experience with raster-scanned carbon ion therapy[J].Radiother Oncol,2015,118(2):272-280.
25李亚楠,周云芝,张楠,等.25例晚期原发性气管支气管镜介入治疗临床分析[J].临床肺科杂志,2015,20(4):619-622.
26陈龙,黄海东,董宇超,等.支气管镜介入在甲状腺癌侵犯气管治疗中的应用[J].中国呼吸与危重症杂志,2016,15(3):266-270.
27朱强,岳岩,朱立成,等.氩等离子体凝固术治疗气管腺样囊性癌19例效果分析[J/CD].中华腔镜外科杂志:电子版,2018,11(4):228-233.
28王洪武,金发光,柯明耀.支气管镜介入治疗[M].北京:人民卫生出版社,2012:46-47,100-101.
29 Sherani K,Vakil A,Dodhia C,et al.Maligant tracheal tumous:a review of current diagnostic and management strategies[J].Curr Opin Pulm,2015,21(4):322-326.
30陶梅梅,王洪武,周云芝,等.支气管镜下不同方式治疗气管腺样囊性癌的疗效比较[J].国际呼吸杂志,2013,33:911-914.
31 Zhao Y,Zhao H,Fan L,et al.Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart[J].Ann Thorac Surg,2013,96(6):1998-2004.