摘要目的 通过对肺腺泡型及乳头型为主腺癌间质中不同等级的弹力纤维表达进行观察和分析,探讨不同弹力纤维等级的临床及预后意义.方法 收集194例术后病理诊断为腺泡型及乳头型为主且最大径小于3 cm的腺癌标本并行弹力纤维染色,根据染色结果分为完全缺失(Ⅰ级)、部分缺失(Ⅱ级)以及正常或增生(Ⅲ级)3个等级,并分析其与临床预后的关系.结果 194例纳入此研究,其中67例(34.5％)为Ⅰ级,70例(36.1％)为Ⅱ级,57例(29.4％)为Ⅲ级;Ⅰ级、Ⅱ级淋巴结转移率较Ⅲ级明显增加,Ⅰ级为35.8％ (24/67),Ⅱ级为40.0％(28/70),Ⅲ级为10.5％(6/57),弹力纤维Ⅰ级、Ⅱ级病例比例随肿瘤最大径的增大而增加,肿瘤最大径≤2.0 cm的Ⅰ级、Ⅱ级比例为55.1％(38/69),肿瘤最大径2.1～3.0 cm的Ⅰ级、Ⅱ级比例为79.2％(99/125).所有病例5年总生存率为75.8％,不同弹力纤维等级5年生存率分别为:Ⅰ级67.2％、Ⅱ级68.6％、Ⅲ级94.7％.结论 中级别的腺癌(腺泡型及乳头型为主)其临床预后不如高级别及低级别腺癌明确,对于肿瘤间质弹力纤维的观察与分级有助于评估肿瘤的侵袭程度及患者的临床预后.

abstractsObjective To evaluate the role of elastic fiber changes in predicting survival outcomes in intermediate-grade lung adenocarcinoma.Methods All pulmonary adenocarcinoma resections conducted between January 2009 and December 2009 were reviewed.Pathologically confirmed adenocarcinomas smaller than 3 cm were included in the present study.All cases were categorized into three elastic fiber patterns (EFP):complete loss as pattern Ⅰ (EFP Ⅰ),partial loss as pattern Ⅱ (EFP Ⅱ),normal and diffusely increase as pattern Ⅲ (EFP Ⅲ).Patients with different EFP were compared.Results One hundred and ninety four patients were included in this study,with 67 (34.5％),70 (36.1％) and 57 (29.4％) cases presenting as EFP Ⅰ,EFP Ⅱ,and EFP Ⅲ,respectively.Lymph nodal metastases occurred in 35.8％ (24/67),40.0％ (28/70),and 10.5％ (6/57) of EFP Ⅰ,EFP Ⅱ and EFP Ⅲ patterns,respectively.The percentage of EFP Ⅰ and Ⅱ increased with increasing tumor size,these patterns occurring in 55.1％ (38/69) of tumors ≤2.0 cm,and 79.2％ (99/125) of tumors 2.1-3.0 cm in sizes,respectively.The overall 5-year overall survival rate was 75.8％,and 67.2％ for EFP Ⅰ,68.6％ for EFP Ⅱ,and 94.7％ for EFP Ⅲ.Conclusion In patients with intermediate-grade lung adenocarcinoma,EFP should be formally recognized as a feature of tumor invasion,and its evaluation can help to recognize tumor invasive and access clinical prognosis.