The Retrospective Study Of 42 Patients With Primary Pulmonary Mucinous Adenocarcinoma

Objective:In this paper,the clinical data,treatment and prognosis of 42 patients with primary pulmonary mucinous adenocarcinoma were retrospectively studied,and their current clinical treatment programs were discussed,to further improve the understanding of the disease.Methods:The clinical data of 42 patients with primary pulmonary mucinous adenocarcinoma admitted from January 2015 to December 2017 in our department were retrospectively reviewed and the related literatures were reviewed.Results: The incidence of primary pulmonary mucinous adenocarcinoma(PPMA),male and female age of onset was no significant difference(P>0.05),the highest incidence was50-60 years old group.The main clinical manifestations were cough,white mucus-like sputum,and 30.95% of people without any clinical manifestations.40 cases(95.23%)were peripheral lung cancer,2 cases were central lung cancer.Chest CT showed irregular nodules,ground glass or irregular soft tissue mass with lobulation or burr sign,with pleural traction depression and thickening.Among them,20 cases(47.62%)had preoperative tumor marker increased,the most common tumor markers were NSE(10cases,50%),CEA(8 cases,40%),CYFRA21-1(6 cases,30%).Microscopic observation of cancer cells were highly columnar.The nucleus was located on the basement and the mucus was seen in the pulp.The cancer cells grew on the alveolar wall,showing the formation of mucoid lakes with different sizes.The irregularly shaped cells were floated and irregularly arranged adenoid and infiltrative growth.19 cases did immunohistochemistry,the vast majority of CK7,TTF1,Napsin A positive,and CK20,CDX-2 negative.25 patients underwent postoperative gene detection,EGFR gene mutation positive only 1 case,the positive rate was 4%.Four positive cases of EML4-ALK fusion gene were detected,the positive rate was 16%.KRAS gene mutation was positive in 8 cases,the positive rate was 32%.20 cases with single-hole thoracoscopic surgery compared with 18 cases with three-hole thoracoscopic surgery.The operation time,the single-hole group was(217.90±24.81)min,the three-hole group was(155.06±27.34)min,the time of the single hole group was longer than that of the three-hole group,the difference between the two groups was statistically significant(P<0.05).On the first day postoperative pain score,single hole group was better than the three hole group,the difference between the two groups was statistically significant(P<0.05).The postoperative hospital stay time,single-hole group was shorter than the three-hole group,the difference between the two groups was statistically significant(P <0.05).For intraoperative bleeding,the single-hole group(63.75±15.29)ML and the third-hole group(161.67±211.92)ML,the amount of bleeding in the single-hole group was less than that in the three-hole group,the difference between the two groups was statistically significant(P<0.05).Lymph node sweeping group number,thoracic tube indwelling time,drainage on the first postoperative day,drainage on the third postoperative day,the number of postoperative complications,there was no significant difference between the two groups(P>0.05).42 cases of PPMA patients,5 cases were lost to follow-up,6 died,the death occurred in the lung,lymph nodes,and even head and bone metastases,the most common was bone metastases.Conclusion:1.PPMA with non-specific clinical manifestations,easily misdiagnosed as other diseases of the lungs and is delayed,the majority is peripheral lung cancer,chest CT has a certain specificity,the diagnosis requires pathological biopsy and immunohistochemistry.2.When the middle-aged and elderly of pulmonary occupying with cancer markers increased,should pay attention to the review and early diagnosis,so as not to delay the disease.3.Surgical treatment is the preferred method,single-hole thoracoscopic surgery with less bleeding,less postoperative pain,fast recovery,shorter hospitalization time,is a safe and effective surgical approach,be worth promoting.4.The prognosis of Early PPMA is good,late prognosis is poor and prones to bone metastases.5.The current postoperative chemotherapy is consistent with other adenocarcinomas,but PPMA has its own particularity and can be found in larger samples for better programs.6.Genetic testing is still not enough attention clinically,the main gene testing should be the EML4-ALK fusion gene,patients can benefit from oral targeted drugs.