| Objectives: The aim of this study is to analyze the clinical characteristic,radiological,pathologic characteristic,treatment and prognostic factors of Primary Pulmonary Mucinous(Colloid)Adenocarcinoma PPMA,so as to improve the understanding of the disease,Being prepare for Disease diagnosis and treatment well in the future.Methods:Upon pathological diagnosis of the complete 79 cases of PPMA in the Thoracic surgery department of the the first afficiated hospital of the dalian medical university from January 2011 to January 2016 who got surgery and were confirmed by postoperative pathology,the follow-up data included the gender,age,clinical manifestation,familial cancer history,smoking history,CEA、cyfra21-1、FVC,FVC%,FEV1,MVV,TNM stage,preoperative complications,etc.CT manifestations included tumor location,maximal diameter of the tumor,pleural invasion,lymph node metastasis,vessel invasion,characteristic manifestations(lobes,burrs,voids,pleural depressions,vascular access,bronchial sign),treatment,including surgical approach,duration of operation,drainage tube retention time,intraoperative blood loss,length of stay,complications,postoperative adjuvant therapy and other factors;The survival rate was calculated by Kaplan-Meier method,Log-rank was used to detect the significant survival rate,and the Cox proportional regression risk model was used to evaluate the prognosis with univariate analysis and coxanalysis.Results: 79 cases of primary lung adenocarcinoma,35 males and 34 females,accounting for 2.16% of the patients confirmed lung cancer in the same period after surgery in our department.Among them,there were 39 cases(49.4%)of pure Primary Pulmonary Mucinous,2 cases(2.5%)of micro-invasion adenocarcinoma,37 cases(46.8%)of mixed Primary Pulmonary Mucinous,3 cases of central type lung cancer,and 76 cases of peripheral lung cancer.The age of onset was 62.04±8.8.Of the patients,52 cases(65.8%)came for treatment when they found the shadow of the lung during physical examination,36 cases(45.6%)at least appeared one clinical symptoms,mostly were cough,sputum,chest tightness,including 5 patients found blood in the sputum,1 cases was found hemoptysis.15 patients were smokers,all of whom were males.CEA increased in 16 cases,cyfra21-1 increased in 39 cases,FVC average(2.87 ± 0.76)L,FVC% average(84.80 ± 14.62)%.FEV1 average(2.43 ± 0.69)L,MVV average(94.19±34.19)L/min.TNT stages: 59 cases(74.68%)were in stage I,12 cases(15.19%)were in stage II,7cases(8.86%)were in stage III,and 1 cases(1.3%)were in stage IV.tumor location:10cases(12.65%)had tumor in their superior lobe of left lung,22 cases had tumor in their inferior lobe of left lung,13 cases(16.46%)had tumor in superior lobe of right lung,5cases(6.32%)had tumor in their middle lobe of right lung,27 cases had tumor in their inferior lobe of right lung,and the tumor invaded the lower middle lobe of right lung occurred in 2 cases(2.5%).focal long diameter is 0.8-8cm,short diameter is 0.4-4.6cm.CT showed that there were 70(88.6%)cases of Vascular access,42cases(53.16%)of lobulation,56 cases(70.89%)of speculated signs,30 cases(38.0%)of air bronchogram,12 cases(15.19%)of cavity,and 52 cases(65.82%)of pleural pulling.All of the 79 patients received surgery,and postoperative pathology confirmed 4 cases of lymph node metastasis,52 cases of pleural invasion,10 cases of vasculitis,among which 63 cases(79.75%)were VATS and 17 cases(21.52%)were open surgery.The mean operative time was(3.2 ± 1.06)h,the mean blood loss was(36.01 ± 34.65)ml,the mean diameter of lead drainage was(3.90 ± 2.05)d,the mean hospital stay was(11.10 ±4.41)d.25 patients received routine operation combined postoperative chemotherapy after operation,and 5 patients received routine surgery combined with postoperative radiotherapy and immunotherapy.Among them,a patient appeared head,body bone metastasis after 6 months and died in 10 months after surgery,another patient who combined 4 stages chemotherapy after surgery appeared bilateral,body bone metastasis after a year and died in 44 months,anther patient who received postoperative chemotherapy were found head,chest lymph node metastasis after 25 months,and he was alive with chemoradiotherapy.55 cases didn’t show recurrence or metastasis would under follow-up observation.Of all the patients,94% were alive a year later,74% at 3 years and 71% at 5 years,and the mean survival rate was 60 months.Univariate analysis showed that clinical TNM staging(P = 0.002),bronchial inflation(P = 0.019),surgical procedure(P = 0.017)were the factors that affected prognosis.Cox regression multivariate analysis showed that there was no independent factor affected prognosis.Conclusion:1.The mostly common type of the PPMA is the peripheral lung cancer,there are no typical clinical characteristic of the PPMA.2.The solid nodules is the mostly common radiological characteristic,the air bronchogram is the speculated sign of the radiological characteristic,,it is also the factor that affected prognosis.3.TNM stage is the factor that affected prognosis.the earlier of the TNM stage,the better of the prognosis4.surgery is the effective,curable method of the treatment and diagnosis,it is also the factor that affected prognosis. |
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