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目的探讨青年(≤40岁)非小细胞肺癌(NSCLC)患者的临床特点、手术疗效,分析影响预后的因素。方法回顾性分析苏州大学附属第四医院2000年1月至2009年12月经手术治疗48例40岁以下青年NSCLC患者的临床资料,其中男31例,女17例;年龄(32±6)岁。29例术前明确为NSCLC,12例术前高度怀疑为肺癌,7例误诊为肺良性疾病;手术根治性切除37例,姑息性切除9例,手术探查2例。结果术后并发症发生率12.5%(6/48),1例死于探查术后呼吸衰竭,病死率2.1%(1/48)。术后组织病理学检查示腺癌26例,鳞癌16例,腺鳞癌5例,大细胞肺癌1例。术后病理分期示Ⅰ期3例,Ⅱa期9例,Ⅱb期15例,Ⅲa期17例,Ⅲb期3例,Ⅳ期1例。随访45例,随访率93.8%(45/48),随访时间23(3～120)个月。总的3年和5年生存率分别为39.6%和25.0%。肿瘤TNM分期、淋巴结转移状况、肿瘤直径、手术性质、术前新辅助化疗及术后规则放化疗是影响预后的重要因素,肿瘤TNM分期是影响患者预后最主要的因素。结论青年NSCLC误诊率高,恶性程度高,分期偏晚,手术根治性切除率偏低,应加强早诊早治意识。手术根治仍是青年NSCLC患者治疗的首选。
Objective To investigate the clinical features, surgical outcomes of young patients (≤40 years old) with non-small cell lung cancer (NSCLC) and to analyze the factors influencing the prognosis. Methods The clinical data of 48 patients with NSCLC under the age of 40 undergoing surgical treatment at Fourth Affiliated Hospital of Soochow University from January 2000 to December 2009 were retrospectively analyzed. There were 31 males and 17 females with a mean age of 32 ± 6 years. Twenty-nine cases were preoperatively identified as NSCLC, 12 cases highly suspected as lung cancer preoperatively, and 7 cases misdiagnosed as benign pulmonary diseases. There were 37 cases underwent radical resection, 9 cases underwent palliative resection and 2 cases underwent surgical exploration. Results The incidence of postoperative complications was 12.5% (6/48). One patient died of respiratory failure after exploration. The case fatality rate was 2.1% (1/48). Postoperative histopathological examination revealed adenocarcinoma in 26 cases, squamous cell carcinoma in 16 cases, adenosquamous carcinoma in 5 cases and large cell lung carcinoma in 1 case. Postoperative pathological staging showed 3 cases in stage Ⅰ, 9 cases in stage Ⅱ a, 15 cases in stage Ⅱ b, 17 cases in stage Ⅲa, 3 cases in stage Ⅲb and 1 case in stage Ⅳ. Follow-up 45 cases, follow-up rate was 93.8% (45/48), followed up for 23 (3 to 120) months. The overall 3-year and 5-year survival rates were 39.6% and 25.0% respectively. Tumor TNM stage, lymph node metastasis, tumor diameter, surgical properties, preoperative neoadjuvant chemotherapy and postoperative regular radiotherapy and chemotherapy are important prognostic factors. TNM staging is the most important factor affecting the prognosis of patients. Conclusion The misdiagnosis rate, high malignant degree, late stage of NSCLC in young patients and low radical radical resection rate should be strengthened. Surgical radicalization is still the first choice for the treatment of young NSCLC patients.