Clinical Analysis Of 1158 Cases Of Primary Bronchogenic Lung Cancer In Pathology

[Background] The morbidity and mortality of lung cancer have raised greatly during the past 50 years, being No.1 in the world. Lung cancer falls into small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC). The latter is divided into squamous carcinoma, adenoma, large cell carcinoma, ect. Different pathological type has its own characteristics, and demonstrates different rules with era and area,and at the same time it is closely related with prognosis.At present ,our province lacks large-scaled clinical analysis on pathological type of lung cancer.This paper conducted retrospective analysis on lung cancer patients admitted to our hospital in recent four years,compared the charateristics of cancer onset and clinical pathology in our province with that of other areas,providing evidence for epidemiologic study of lung cancer.[Materials and Method]: 1158 cases of bronchiogenic carcinoma were enrolled, from Jan. 2003 to Feb.2007, China-Japan Union Hospital. All of them were primarily diagnosed with cytology or pathology examination. Clinical features of different pathological types of the cases were analyzed with EXCEL dataanalysis tools.[Results]The state of disease onset :squamous carcinoma was most frequently seen in lung cancer(38.67%) ,followed by adenoma (35.49% ),SCLC(23.38%),in order . The ratio of squamous carcinoma and adenoma was 1.09:1. The ratio of gender: male/female ratio in the whole group was 1.89:1, squamous carcinoma and SCLC were more common male(4.74:1,1.60:1 separately), while in adenoma, the number of man and woman was similar(0.98:1). Disease- onset age: the mean onset age decreased in order as follows, squamous carcinoma 59.33,adenoma 58.69, SCLC 54.43. Almost half of the patients had definite smoking history ( 47.36% ) .When smoking index is above 400,incidence of squamous carcinoma rose with the growth of smoking index , incidence of SCLC was similar with that of total lung cancer , incidence of adenoma hasn't changed much. Squamous carcinoma is greatly related with chronic bronchitis, emphysema and pulmonary TB. The incidence of multi-primary cancer is 1.64%. Primary focus is commonly seen in right (53.80%)and upper lobe(52.54%),with more types of central tumors than peripheral ones(75.77% vs 24.23%,P<0.01). Thereare no statistical differences among all pathology types with regard to the primary focus. Central type is common in squamous carcinoma and SCLC.Clinical manifestation:SCLC easily irritated displayed cough(71.2%),chest distres(s33.9%)and short breath(31.9%).while blood in sputum was easily seen in squamous carcinoma (42.8%).In adenoma , chest, back and bone pains were common symptoms. Mean admission time reduced in squamous carcinoma(137.73days),adenoma(117.41days),SCLC(100.09days) in order. Percentage of adenoma was higher than that of other groups among 45 asymptomatic patients(P<0.05). 72.70% of lung cancer showed lump image,a few were millet image(4.46%)and cavitating image(2.97%)。Frequency of spike was higher in adenoma(24.11%) than that of other groups(P< 0.01 )。SCLC,pulmonary atelectasis was common in squamous carcinoma ( P < 0.01 )。The manifestation of bronchoscope : proliferating type is common in squamous carcinoma (58.12%,P<0.01),while in adenoma infiltrating(34.62%) and non-abnormal(37.69%)types were common.Diagnosis and Staging : SCLC and adenoma obtained cytological evidence mainly with BronchoalveolarLavage(47.06%) or brush biopsy(55.25%).The percentage of getting cytological evidence with pleural effusion in adenoma was higher than that of other types(1%-5%).The coincidence rate of bronchoscopic cytological diagnosis and pathological diagnosis was (87.3%),many were misdiagnosed as squamous carcinoma. half of the patients primarily diagnosed as SCLC were in extensive stage (53.48%).503 cases were able to do clinical staging, the percentage of IIIB stage in adenoma was higher than that of squamous carcinoma(82.59vs44.78%,P<0.01).Metastasis: The rate of lymphadenectasis, bone , liver and brain metastasis of SCLC and adenoma is higher than that of squarmous carcinoma(P<0.05).[Discussion]The percentages of squamous carcinoma (38.67%) and SCLC (23.38%) were higher than that of other areas at home and abroad, possibly due to the high smoking rate in northeastern part of China. The number of men was much higher than that of women in squamous carcinoma and SCLC while in adenoma, male/female ratio was about 0.98. Male/female ratio of every type of lung cancer in this report is similar with that of Shenyang reported by Jia Xinshan in 2001.Peak of onset ages of lung cancer was among50-60, lower than that of other parts of china and western countries, probably due to the lower ratio of young and old people than other areas. When smoking index is above 400, smoker ratio of squamous carcinoma group rose significantly with the increase of smoking index, which indicated that smoking index above 400 was the one of main risk factors of squamous carcinoma. Among the patients of lung cancer with COPD,pulmonary TB, silicosis, main pathology type was squamous carcinoma.Probably because of squamous metaplasia and canceration of bronchial epithelium by chronic physiochemical inflammation and irritation. Primary foci were commonly seen in right lobe ,with more central types than peripheral ones(75.77% vs 24.23%,P<0.01). No correlations were shown among pathological types, incidence of left and right lung cancers, distribution of upper and lower lobes through independent test. Most of squamous carcinoma and SCLC were central types.Clinical menifestation:Irritative dry cough,chest distress,short breath were more seen in SCLC,for the reason that SCLC in large airway irritates bronchial mucosa and obstructs airway.Blood in spectrum was frequently seen in squamous carcinoma which easily induces ulcerative necrosis,hemorrhage of bronchial mucosaadenoma. The percentage of frequency of chest ,back and bone pains were higher than that of other types, because of its pleura invasion and bone metastasis. The ratio of asymptomatic patients was higher than that of other groups(P<0.05), probably because adenoma are common in peripheral and its symptoms are insidious.In imaging, spike is a radiate short strip-like image produced by tumors invading peripheral tissues and the tissues'response on tumors Similar with documents, frequency of spike was higher in adenoma than that of other groups ,because of its strong invasiveness. infiltrating and surpressing types. The appearance through the bronchoscope is closely related with its histology type. pulmonary atelectasis in SCLC and squamous carcinoma was higher than that of adenoma. Because squamous carcinoma is liable to inward growth,SCLC invades bronchial wall,obstructs it,while most adenoma are peripheral types with thick mucosa,rarely cause pulmonary atelectasis. More than half of squamous carcinoma were proliferating types when detected by bronchoscope, in line with documents However, more patients of adenoma were not seen abnormal than that of squamous carcinoma(P<0.01), that may because peripheral adenoma though frequent, could not be reached by bronchoscope.Most of SCLC, squamous carcinoma gained cytological evidence through bronchoscope, while in adenoma the rate of the method was relatively low. Central type is more common in SCLC and squamous carcinoma while in adenoma, peripheral type is more frequently seen. More importantly, the fact that bronchoscope can reach limited area determines the disparity. The rate that adenoma obtained cytology evidence through hydrothorax is higher than other types of lung cancer, possibly due to the incidence of hydrothorax in adenoma. The diagnostic consistency rate of cytology and pathology gained through operation is 87.3%, slightly lower than documents(95%). Many of the cases were misdiagnosed as squamous carcinoma using bronchoscopic cytology, that is probably because smoking, COPD can cause the proliferation and metaplasia of bronchial epithelial cells and basal cells. 53.48% of SCLC in this report were extensive stage diseases,consistent with documents. In adenoma, the percentage of patients over IIIB stage was higher than that of squamous carcinoma (P<0.05).The rates of lymph node and bone, liver and brain metastasis in adenoma and SCLC were higher than that of squamous carcinoma(P<0.05),in accordance with literatures.Bone metastasis was mainly seen in adenoma(10.77%),while brain and liver metastasis rate was highest in SCLC, which were 6.23%,7.39% separately. Pleural and pericardial effusion was more easily seen in adenoma than other types of lung cancer. SCLC and adenoma are liable to metastasis.All in all, the pathology types of lung cancer are being different according to distinct time and area, especially their own characteristics.