CAJ | 학술논문

目的了解间质性肺疾病合并肺癌的临床特点和治疗.方法回顾性分析12例北京协和医院住院患者中诊断间质性肺疾病合并肺癌患者的临床症状、影像学、病理、治疗及预后.结果 12例患者,平均年龄(61±8)岁,男女比例11:1,平均吸烟指数(26±5)包·年,8例为特发性肺纤维化.临床表现包括干咳(10/12)、活动后气短(9/12),肺癌发生后可出现咯血(1/12).肺癌病理类型以腺癌(4/12)和鳞癌(5/12)为主,还包括复合癌(2/12)、小细胞肺癌(1/12).胸部影像学表现为原有间质性疾病基础上新出现的结节团块影,主要在下叶外带(7/12).肺癌的治疗出现的并发症包括间质性肺疾病急性加重(1/12)、肺部感染(3/12).特发性肺纤维化合并肺癌占同期全部特发性肺纤维化住院患者15％(8/54),特发性肺纤维化合并肺癌组住院病死率(38％)高于单纯特发性肺纤维化组(15％).结论间质性肺疾病合并肺癌发生率高,临床表现不特异,影像学检查有助于早期诊断,肺癌治疗易引起间质性肺疾病急性加重,慎重选择治疗方案,并密切监测治疗过程.
목적 료해간질성폐질병합병폐암적림상특점화치료.방법 회고성분석12례북경협화의원주원환자중진단간질성폐질병합병폐암환자적림상증상、영상학、병리、치료급예후.결과 12례환자,평균년령(61±8)세,남녀비례11:1,평균흡연지수(26±5)포·년,8례위특발성폐섬유화.림상표현포괄간해(10/12)、활동후기단(9/12),폐암발생후가출현각혈(1/12).폐암병리류형이선암(4/12)화린암(5/12)위주,환포괄복합암(2/12)、소세포폐암(1/12).흉부영상학표현위원유간질성질병기출상신출현적결절단괴영,주요재하협외대(7/12).폐암적치료출현적병발증포괄간질성폐질병급성가중(1/12)、폐부감염(3/12).특발성폐섬유화합병폐암점동기전부특발성폐섬유화주원환자15％(8/54),특발성폐섬유화합병폐암조주원병사솔(38％)고우단순특발성폐섬유화조(15％).결론 간질성폐질병합병폐암발생솔고,림상표현불특이,영상학검사유조우조기진단,폐암치료역인기간질성폐질병급성가중,신중선택치료방안,병밀절감측치료과정.
Objective To understand the clinical features and treatment of lung cancer associated with interstitial lung disease(ILD-Ca).Methods Twelve patients with ILD-Ca were retrospectively studied in Peking Union Medical College Hospital.Their clinical features,chest radiography,pathology,therapy and prognosis were analyzed.Results The mean age at presentation was(61±-8)years,11 were man.Lung cancer was found in(3± 2)years after the diagnosis of ILD.The average smoking index was (26±5)packet · year.There were eight cases of idiopathic pulmonary fibrosis(IPF),three cases of rheumatoid arthritis and one case of nonspecific interstitial lung disease(NSIP).The clinical presentations included dry cough(10/12),shortness of breath(10/12),inspiratory crepitus(10/12)and acropachy (10/12).Those ILD patients had exacerbation of the above(3/12)or hemoptysis(1/12)when they had lung cancer.The cardinal cell types were squamous carcinoma and adenocarcinoma.Besides there were two cases of combined carcinoma(2/12)and one case of non-small cell lung cancer(1/12).The stage of lung cancer was always later(9/12).The pathology of ILD associated with lung cancer included usual interstitial pneumonia and NSIP.The cancer was mostly located in the periphery of the lower lobe (7/12),which was mainly single nodule(9/12).The complication included acute exacerbation of ILD (AE-ILD)(1/12),pulmonary infection(3/12)after lobectomy,chemothepary or radiotherapy of lung cancer.Lung cancer associated with IPF(IPF-Ca)occupied 15％ of all IPF patients.The hospital mortality of IPF-Ca(38％)was higher than the IPF without lung cancer(15％).Conclusions ILD is always combined with lung cancer,which has worse prognosis.Bacause of un-specific clinical presentations and misdiagnosis,ILD-Ca is always ignored.The change of chest radiology is beneficial to early diagnosis.The therapy of lung cancer always results in more severe pulmonary complications,such as AE-ILD.So the treatment needs more careful consideration and monitor.