Retrospective Analysis Of Clinical Cases Of Lung Adenosquamous Carcinoma

Backround:Lung cancer is currently the most common malignancy in terms of globalmorbidity and mortality.In general,lung cancer is divided into small cell lung cancer(SCLC)and non-small cell lung cancer(NCLC);lung adenosquamous carcinoma is rare in lung cancer(0.4%to 4.0%of lung cancer)[1],one of the special types of non-small cell lung cancer.ASC is a mixed histologic tumor,as defined by the World Health Organization(WHO)[1],as it has components of both adenocarcinoma(AC)and squamous cell carcinoma(SC),with each comprising at least 10%of the tumor.Pathological classification:According to the different growth modes of the microscope,it can be divided into independent growth type and mixed growth type.The former has space between adenocarcinoma and squamous cell carcinoma,while the other one adenocarcinoma and squamous cell carcinoma have no obvious boundary;According to the proportion of adenocarcinoma and quamous cell carcinoma,it can be divided into adenocarcinoma-predominant type(adenocarcinoma is more than 60%),squamous cell carcinoma is dominant(squamous cell carcinoma is more than 60%),the type of adenocarcinoma and squamous cell carcinoma are equivalent(the proportion of both is between 40%and 60%)[2].Preoperative diagnosis of ASC is not easily diagnosed by bronchoscopic brushing or cell rinsing,and requires a combination of clinical data,pathological features,and immunohistochemical techniques,and if necessary,feasible genetic testing is more clearly defined.Studies have shown that ASC is not a simple combination of AC and SC,it has both the malignant biological characteristics of AC and SC,as well as its unique clinical features.ASC has a higher degree of malignancy and aggressive than AC and SC,and lymphoid and hematogenous metastasis occur earlier.The survival rate is low,the prognosis is poor,and the effect of radiotherapy and chemotherapy is poor[3].Objective:Observe the clinical characteristics of ASC(age of onset,symptoms,smoking history,imaging data,etc.)and summarize general rules;analyze serum levels of tumor markers before and after treatment to explore the relationship between tumor markers and the diagnosis and treatment of ASC,to provide guidance for clinical applications.Methods:1.The clinical data of 34 cases of lung adenosquamous carcinoma diagnosed in Qianfoshan Hospital of Shandong Province from January 2015 to December 2017 were analyzed retrospectively,and the results are discussed in conjunction with the literature.Summarize the symptoms,age,gender,smoking history,tumor site,TNM stage,and imaging data(CT,bone scan,etc.)of the patient.statistics of symptoms,the location of the tumor,and smoking in patients with pulmonary squamous cell carcinoma Tumor development relationship,sex ratio,age of occurrence,and tumor stage at the time of treatment.As the treatment progresses,statistical changes in tumor markers and changes in imaging results are analyzed,and it is analyzed which tumor markers changes are more sensitive with tumor treatment.Record the data into SPSS software and use X2 test and t test for statistical analysis.Results:(1)Among 34 patients with ASC,20 were male and 14 were female.The median age was 62 years.Adenosquamous carcinoma of the lung occurred mostly in the periphery.Peripheral lung adenosquamous cell carcinoma accounted for 64.7%of the patients in this group.More than the left lung,the ratio of this group was 22:12;overall ASC occurred in the right upper lung,accounting for about 35.3%of all patients;smoking index of 400 accounted for 58.8%,and All were male;no specific symptoms were seen at the time of treatment:most of them had common respiratory symptoms such as cough,sputum,sputum with blood,chest pain,and distant metastases in 4 cases.According to TNM staging:2 cases in stage ?a,2 cases in ?b,0 cases in stage ?,10 cases in stage ?a,7 cases in stage ?b,and 13 cases in stage ?;20 cases with TNM stage ? or above in patients with tumor size less than T2,accounting for 50.8%of patients with total ASC.(2)Cytokeratin 19 fragment(CYFRA21-1)in this group of patients with lung adenosquamous carcinoma in each tumor markets(CEA,NSE,CYFRA21-1,SCC,ProGRP)The positive rate,reaching 73.3%;in the case of effective treatment of lung adenosquamous carcinoma,the largest decrease in the index was cytokeratin 19 fragment(CYFRA21-1),which was up to 63.7%.Conclusion:(1)Adenoid squamous cell carcinoma occurs in older men,smoking is an important risk factor for its occurrence;ASC patients with cough,hemoptysis as the main clinical symptoms,the first time for the majority of patients with advanced stage? patients,earlier Lymph node metastasis and distant metastasis;tumors occur in the right upper lobe;(2)Lung cancer tumor marker cytokeratin 19 fragment(CYFRA21-1)may be superior to other lung cancers in the diagnosis and treatment of lung adenosquamous carcinoma Tumor markers(CEA,NSE,SCC,ProGRP).