| Objective:LCWPTB is lung cancer occur in patients with pulmonary tuberculosis on the basis. This study investigated patients’ information, chest imaging features and serum levels of tumor associated antigen(TAA),explore the related prognostic factors of LCWPTB, the goal was to improve the clinical workers understanding of lung cancer after tuberculosis, provide theoretical for early detection,early diagnosis,reasonable treatment of LCWPTB.Methods:Collected data of LCWPTB patients who were hospitalized in the First Affiliated Hospital of Wannan Medical College during the period from March 2004 to August 2014. Through telephone, mail and other methods to follow-up surveyed the patients’ late treatment and living, 55 cases of complete information cases were received in total.Meanwhile, 50 patients with pulmonary tuberculosis as control group. The methods of composition was used to describe clinical characteristics and chest imaging features of LCWPTB;16 influence prognostic characteristics for 55 LCWPTB were analyzed,to predict the independent prognostic factors in LCWPTB.Finally, Five kinds of TAA of the two groups were analyzed for sensitivity, specificity,Youden index,area under the curve(AUC) etc.Results: 1.The ratio of men and women in 55 cases of LCWPTB is about 5 to 1, The median time of the history of tuberculosis is 7 years, Diagnosis of concurrent lung cancer within five years accounted for 41.8%。Pathology:squamous cell carcinoma in 24 cases, adenocarcinoma in 17 cases, 14 cases of other pathological types. The staging of lung cancer in advanced stage(stage III/IV) accounted for 63.64%. 2.The clinical characteristics of LCWPTB and PTB are similar.Through the comparison analysis method know that only the differences of hemoptysis or bloody sputum, angular fatigue, chest or back pain with statistically significant(P < 0.05). 3.By the end of follow-up cut-off time, cumulative death 48 patients,the longest survival time is 58.8 months(still alive), the shortest survival time is only 2.5 months, MST is 12.7 months, 1 year survival rate of LCWPTB is 49.1%, 3 year survival rate of LCWPTB is 12.7%. 4.Kaplan-Meier analysed 16 prognostic factors of LCWPTB and showed that activity, complications(COPD\anemia), lung cancer staging, anticancer treatment, tumor size are associated with survival times. COX multi-factors analysis further confirmed that pulmonary tuberculosis activity(RR=2.38, 95%CI:1.22~4.64), anemia(RR=3.39,95%CI:1.05~10.90),lung cancer TNM staging(RR=2.24, 95%CI: 1.52~3.30),anticancer treatments(RR=0.58,95%CI:0.42~0.80) are relatively independent prognostic factor for LCWPTB. 5.LCWPTB show the tuberculosis, lung cancer imaging characteristics, Clinical workers should pay attention to the original tuberculosis or emerging mass suddenly grow, cavity with thick wall,accompanied with vascular convergence sign, lobulation sign, pleural indentation signs to be wary of complicated with lung cancer. Lesions of tuberculosis and lung cancer is ipsilateral and in the same lobe in 21cases(38.2%);ipsilateral but different lobes in 15 patients(27.3%), contralateral lung in 19 patients(34.5%). 6.The differences of 5 kinds of TAA between LCWPTB group and PTB group only the level of CA199, CEA, SCC in statistically significant(P<0.05).The list of Youden index from high to low is SCC(0.546). CEA(0.543), CA199(0.468), CA125(0.306),FER(0.151). The AUC from high to low is respectively CEA(0.91), SCC(0.85), CAl99(0.73), FER(0.58), CAl25(0.55) by ROC curve analysis.Conclusion:1.LCWPTB occur among older, males more than females. The greater risk of lung cancer within five years after diagnosis of LCWPTB.The major pathological type is squamous carcinoma. The proportion stage III and IV are large. 2.LCWPTB easily tend to be missed diagnosis or misdiagnosis,, but should pay attention to pulmonary tuberculosis patients appears repeated hemoptysis or bloody sputum, angular fatigue,chest or back pain to be wary of complicated with lung cancer,possibility. 3.The anti-tumor treatment after LCWPTB diagnosed should to be comprehensive treatment,which is based on operation,and combine with radiotherapy、chemotherapy and molecular targeted therapy, for the patients with tuberculosis in active period or phase treatment should take into consideration cooperate with anti-tuberculosis treatment. 4.LCWPTB patients’ survival time is short and poor prognosis. The survival time is influenced by t comprehensive factors. If tuberculosis in active period or treatment period, complicated anemia, staging of lung cancer is late, no comprehensive anti-cancer treatment suggests that patients with poor prognosis. 5.Periodically,the high-risk population should be inspection by chest CT, serum TAA examination(CA199+CEA+SCC,especially) which is helpful for lung cancer be early prevention, early screening and early treatment. |
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