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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (01) : 15 -19. doi: 10.3877/cma.j.issn.1674-6902.2022.01.004

论著

气道恶性肿瘤患者光动力治疗24例临床分析
师佩1, 李文洁1, 顾兴1, 冯斐1, 贾丽娟1, 金发光2, 张涛2, 张红军1,†()   
  1. 1. 710100　西安，西安市胸科医院
    2. 710038　西安，空军军医大学第二附属医院
  • 收稿日期:2021-06-17 出版日期:2022-02-25
  • 通信作者: 张红军
  • 基金资助:
    国家自然科学基金资助项目(81672269)

Clinical analysis of photodynamic therapy in 24 patients with airway malignant tumors

Pei Shi1, Wenjie Li1, Xing Gu1, Fei Feng1, Lijuan Jia1, Faguang Jin2, Tao Zhang2, Hongjun Zhang1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, Xi′an Chest Hospital, Xi′an 710100, China
    2. Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Military Medical University, Xi′an 710038, China
  • Received:2021-06-17 Published:2022-02-25
  • Corresponding author: Hongjun Zhang
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引用本文：

师佩, 李文洁, 顾兴, 冯斐, 贾丽娟, 金发光, 张涛, 张红军. 气道恶性肿瘤患者光动力治疗24例临床分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(01): 15-19.

Pei Shi, Wenjie Li, Xing Gu, Fei Feng, Lijuan Jia, Faguang Jin, Tao Zhang, Hongjun Zhang. Clinical analysis of photodynamic therapy in 24 patients with airway malignant tumors[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(01): 15-19.

目的

回顾性分析经电子支气管镜腔内激光光动力疗法(photodynamic therapy, PDT)治疗的气道恶性肿瘤患者临床资料，探讨PDT治疗的规律性。

方法

选择2019年2月至2021年3月由我院呼吸与危重症医学科进行PDT治疗的气道恶性肿瘤患者24例，分别对一般临床资料、PDT治疗情况和治疗后随访，以及治疗后存活患者和死亡患者的特征进行分析。

结果

截止2021年8月7日，PDT治疗后获益最大的患者随访时长达13.2个月，远远大于PDT治疗后获益较小患者的随访时长总生存期(overall survival, OS)4.7个月(P＝0.02)。前者以管腔壁型为主(80%)，而后者以管腔内型为主(50%)(P＝0.034)。前者腔内病变短于后者(中位数分别是3 cm和5 cm，P＝0.03)。前者年轻、病程短、以腺样囊性癌为主，而后者年龄大、病程长、以鳞癌为主(P>0.05)。

结论

管腔壁型、气道腔内病变短，以及年轻、病程短和肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较多；相反，管腔内型、气道腔内病变长，以及年老、病程长和非肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较少。

关键词: 气道恶性肿瘤, 光动力治疗, 临床分析
Objective

The clinical data of patients with airway malignant tumors treated by electronic bronchoscope intracavitary laser photodynamic therapy (PDT) were analyzed retrospectively, to explore the regularity of PDT treatment.

Methods

24 patients with airway malignant tumors treated by PDT were recruited in the Department of Respiratory and Critical Care Medicine of our hospital from February 2019 to March 2021. The general clinical data, PDT treatment and follow-up after treatment, as well as the characteristics of living and dead patients after treatment were analyzed.

Results

As of August 7, 2021, the patients with the greatest benefit after PDT treatment had been followed up for 13.2 months, which was much longer than length of follow-up in patients with less benefit after PDT treatment [the overall survival (OS) of 4.7 months] (P=0.02). The former was mainly lumen wall type (80%), while the latter was mainly lumen type (50%) (P=0.034). The intraluminal lesions in the former were shorter than those in the latter (median 3 cm and 5 cm, respectively, P=0.03). The former was young, short course of disease and mainly adenoid cystic carcinoma, while the latter was old, long course of disease and mainly squamous cell carcinoma (P>0.05).

Conclusion

Patients with lumen wall type, short airway lesions, young, short course of disease and pulmonary adenoid cystic carcinoma may be benefit more from PDT treatment. On the contrary, patients with intraluminal type, long airway lesions, old age, long disease course and non-pulmonary adenoid cystic carcinoma may be benefit less from PDT treatment.

Key words: Malignant tumor of airway, Photodynamc therapy (PDT), Clinical benefit
表1 光动力治疗的肺恶性肿瘤患者一般资料
临床资料 变　量 例数 占比(%)
性别 男 18 75
  女 6 25
年龄 <60岁 12 50
  >60岁 12 50
病理类型 鳞癌 10 41.67
  腺癌 5 20.83
  腺样囊性癌 5 20.83
  小细胞癌 3 12.5
  黏液表皮样癌 1 4.17
病程 <1个月 1 4.17
  1~3个月 6 25
  3~6个月 10 41.7
  6~12个月 2 8.33
  >12个月 5 20.83
气道狭窄类型 管腔壁型 11 45.83
  管腔内型 10 41.7
  混合型 3 12.47
以往接受过的其他治疗 手术 3 12.47
  化疗 4 16.67
  放疗 1 4.17
  镜下治疗 4 16.67
  未治疗 12 50
选取PDT治疗的原因 1 4 16.67
  2 5 20.83
  3 4 16.67
  4 4 16.67
  5 3 12.5
  6 2 8.33
  7 2 8.33
图1 PDT治疗的肺恶性肿瘤患者的生存(率)曲线
表2 光动力治疗肺恶性肿瘤患者的随访情况(n)
项　目 腺样囊性癌(5) 其他(15) 合计(20)
鳞癌(8) 腺癌(4) 小细胞癌(3)
随访结果 存活(4) 死亡(1) 存活(2) 死亡(6) 存活(2) 死亡(2) 存活(2) 死亡(1) 存活(10) 死亡(10)
随访时间(个月) 12.75(5~17) 18(-) 14(12~16) 4.75(1~12) 10.5(9~12) 2(-) 16(13~19) 4(-) 13.2(5~19) 4.73(1~18)
  Z值 - 3.111    
  P值 - 0.002    
表3 存活组和死亡组患者性别、年龄、病理类型、气道狭窄类型及病程等的比较[n(%)]
临床资料 变　量 存活组 死亡组 χ2/Z P值
性别 男 7(70) 8(80) 0.267 0.606
  女 3(30) 2(20)    
年龄 <60岁 7(70) 4(40) 1.818 0.178
  ≥60岁 3(30) 6(60)    
病理类型 鳞癌 2(20) 6(60) 4.133 0.247
  腺癌 2(20) 2(20)    
  小细胞癌 2(20) 1(10)    
  腺样囊性癌 4(40) 1(10)    
气道狭窄类型 管腔壁 8(80) 2(20) 4.496 0.034
  管腔内 2(20) 5(50)    
  混合型 0 2(20) - -
病程[(min~max)(m)]   5.4(1~12) 19.6(2~72) 1.111 0.267
随访时长[(min~max)(m)]   14.4(5~19) 6.6(1~18) 2.955 0.003
肿瘤长度[M(P25~P50)(cm)]   3(2.9~3) 5(3~6) 2.129 0.03
照射总剂量[M(P25~P50)(J)]   450(150~465) 320(195~475) 0.045 0.964
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