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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) ›› 2026, Vol. 19 ›› Issue (04) : 534 -541. doi: 10.3877/cma.j.issn.1674-6902.2026.04.002

论著

胸部SMARCA4缺失型非小细胞肺癌与SMARCA4缺失型未分化肿瘤的组织病理学特征、影像学表现及预后分析
李春艳1, 郎广碧2, 周亚1, 陈晓龙1,†(), 胡明冬3,†()   
  1. 1400037　重庆，陆军（第三）军医大学第二附属医院老年医学与特勤医学科
    2408200　重庆，丰都县人民医院感染性疾病科
    3400038　重庆，陆军（第三）军医大学第一附属医院老年医学与特勤医学科
  • 收稿日期:2026-05-27 出版日期:2026-08-25
  • 通信作者: 陈晓龙, 胡明冬
  • 基金资助:
    国家自然科学基金青年项目(32301155)

Clinicopathological features, imaging manifestations and prognostic analysis of thoracic SMARCA4-deficient non-small cell lung cancer and SMARCA4-deficient undifferentiated tumor

Chunyan Li1, Guangbi Lang2, Ya Zhou1, Xiaolong Chen1,†(), Mingdong Hu3,†()   

  1. 1Department of Geriatrics and Special Military Medicine, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037
    2Department of Infectious Diseases, Fengdu County People′s Hospital , Chongqing, 408200
    3Department of Geriatrics and Special Military Medicine, The First Affiliated Hospital of Army Medical University, Chongqing 400038
  • Received:2026-05-27 Published:2026-08-25
  • Corresponding author: Xiaolong Chen, Mingdong Hu
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引用本文：

李春艳, 郎广碧, 周亚, 陈晓龙, 胡明冬. 胸部SMARCA4缺失型非小细胞肺癌与SMARCA4缺失型未分化肿瘤的组织病理学特征、影像学表现及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 534-541.

Chunyan Li, Guangbi Lang, Ya Zhou, Xiaolong Chen, Mingdong Hu. Clinicopathological features, imaging manifestations and prognostic analysis of thoracic SMARCA4-deficient non-small cell lung cancer and SMARCA4-deficient undifferentiated tumor[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 534-541.

目的

探讨胸部SMARCA4缺失型非小细胞肺癌(SMARCA4-deficient non-small cell lung cancer, SMARCA4-dNSCLC)及SMARCA4缺失型未分化肿瘤(SMARCA4-deficient undifferentiated tumor, SMARCA4-UT)患者的临床特征、影像学表现、组织病理学特点及治疗预后，以提高对该疾病认识。

方法

回顾性分析2022年11月至2025年4月陆军军医大学第二附属医院收治的37例胸部SMARCA4缺失型肿瘤(SMARCA4-deficient tumor, SMARCA4-DT)患者，将其分为SMARCA4缺失型非小细胞肺癌(SMARCA4-dNSCLC)10例，SMARCA4缺失型未分化肿瘤(SMARCA4-UT)27例，比较患者的性别、年龄，吸烟史，临床症状，东部肿瘤协作组体能状态评分(Eastern Cooperative Oncology Group, ECOG)、肿瘤CT位置、肿瘤大小、肿瘤密度、肿瘤强化均匀度、转移部位、分期、组织病理特征及预后。

结果

与SMARCA4-dNSCLC相比，SMARCA4-UT其肿瘤直径更大、肿瘤密度及强化均匀度极不规则，且临床分期偏晚、纵隔淋巴结转移较常见，Ki-67指数高；整体总生存期(overall survival, OS)短；差异有统计学意义(P<0.05)；临床表现、ECOG体能状态评分、远处转移部位差异无统计学意义，(P>0.05)；SMARCA4-dNSCLC的组织学形态呈现多种低分化NSCLC形态；SMARCA4-UT的组织学形态分化较差，并失去了上皮癌的形态特征，表现为横纹肌样形态。肿瘤早期以手术为主，晚期则以化疗联合免疫治疗为核心方案，但两类肿瘤总体预后极差，中位总生存期(median overall survival, mOS)均较短。本文SMARCA4-dNSCLC患者的中位生存期为14个月，而SMARCA4-UT的中位生存期为5个月，差异有统计学意义(P<0.05)。

结论

SMARCA4-dNSCLC与SMARCA4-UT均具有高侵袭性、病情进展迅速、预后差的特点，而SMARCA4-UT恶性程度更高、进展更快、预后更差，两者在影像学表现、组织病理学特点及预后方面存在差异，临床可将SMARCA4常规纳入低分化、未分化胸部肿瘤免疫组化检测，早期识别并准确分型对评估病情与指导治疗具有重要临床意义。

关键词: 胸部SMARCA4缺失型非小细胞肺癌, SMARCA4缺失型未分化肿瘤, 组织病理学特征, 影像学表现, 预后
Objective

To explore SMARCA4-deficient non-small cell lung cancer in the chest Clinical characteristics, imaging manifestations, histopathological features and treatment prognosis of patients with SMARCA4-dNSCLC and SMARCA4-deficient undifferentiated tumors (SMARCA4-UT) To enhance the understanding of the disease.

Methods

A retrospective analysis was conducted on 37 patients with SMARCA4-deficient tumors (SMARCA4-DT) in the chest admitted to the Second Affiliated Hospital of Army Medical University from November 2022 to April 2025. They were divided into 10 cases of SmarCA4-deletion non-small cell lung cancer (SMARCA4-dNSCLC) and 27 cases of SmarCA4-deletion undifferentiated tumor (SMARCA4-UT). The gender, age, smoking history, clinical symptoms, Eastern Cooperative Oncology Group (ECOG) performance status score, tumor CT location, tumor size, tumor density, uniformity of tumor enhancement, metastasis site, stage, histopathological characteristics and prognosis of the patients were compared.

Results

Compared with SMARCA4-dNSCLC, SMARCA4-UT has a larger tumor diameter, extremely irregular tumor density and enhancement uniformity, a later clinical stage, more common mediastinal lymph node metastasis, and a higher Ki-67 index. The Overall Survival (OS) is short. The difference was statistically significant (P<0.05); There was no statistically significant difference in clinical manifestations, ECOG performance status score, and distant metastasis sites (P>0.05). The histological morphology of SMARCA4-dNSCLC presents various poorly differentiated NSCLC morphologies. The histological morphology of SMARCA4-UT is poorly differentiated and has lost the morphological characteristics of epithelial carcinoma, presenting as rhabdoid morphology. Surgery is the main treatment for early-stage tumors, while chemotherapy combined with immunotherapy is the core regimen for advanced-stage tumors. However, the Overall prognosis of both types of tumors is extremely poor, and the Median Overall Survival (mOS) is relatively short. The median survival period of SMARCA4-dNSCLC patients in this article was 14 months, while that of SMARCA4-UT was 5 months, and the difference was statistically significant (P<0.05).

Conclusion

Both SMARCA4-dNSCLC and SMARCA4-UT have the characteristics of high invasiveness, rapid disease progression and poor prognosis. However, SMARCA4-UT has a higher degree of malignancy, faster progression and worse prognosis. There are differences between the two in terms of imaging manifestations, histopathological features and prognosis. SMARCA4 can be routinely incorporated into the immunohistochemical detection of poorly differentiated and undifferentiated thoracic tumors in clinical practice. Early identification and accurate classification are of great clinical significance for evaluating the condition and guiding treatment.

Key words: Chest non-small cell lung cancer with SMARCA4 deletion, Smarca4-deficient undifferentiated tumor, Histopathological features, Imaging manifestations, Prognosis
表1 两者临床特征结果比较[n(%)，(±s)]
临床特征 SMARCA4-dNSCLC(n＝10) SMARCA4-UT(n＝27) t/χ2值 P值
男性[n(%)] 9(90.00) 27(100.00) 2.775 0.270
平均年龄(±s) 63.90±8.76 63.04±7.43 0.299 0.767
吸烟史[n(%)] 9(90.00) 26(96.30) 0.566 0.473
COPD合并史[n(%)] 2(20.00) 6(22.22) 0.021 1.000
咳嗽咳痰[n(%)] 4(40.00) 19(70.37) 2.862 0.132
胸痛[n(%)] 2(20.00) 3(11.11) 0.493 0.597
呼吸困难[n(%)] 1(10.00) 7(25.93) 1.092 0.404
痰中带血/咯血[n(%)] 1(10.00) 5(18.52) 0.390 1.000
全身疼痛[n(%)] 1(10.00) 2(7.40) 0.666 1.000
ECOG评分[n(%)]     0.735 0.941
0分 2(20.00) 5(18.52)    
1分 6(60.00) 14(51.85)    
2分 1(10.00) 6(22.22)    
3分 1(10.00) 2(7.41)    
4分 0 0    
5分 0 0    
图1 SMARCA4-dNSCLC与SMARCA4-UT影像学表现；图A为SMARCA4-dNSCLC左肺上叶尖后段见不规则软组织密度影，边缘较多浅分叶(肺窗)；图B为SMARCA4-dNSCLC肋骨溶骨性骨质破坏(红色箭头)，病灶与邻近左后胸壁肌肉分界不清(纵隔窗)；图C为SMARCA4-UT右上肺纵隔旁可见团块状软组织密度影，边缘分叶，轮廓不规整(肺窗)；图D为SMARCA4-UT增强扫描不均匀强化(红色箭头)，(纵隔窗)
表2 两者影像学特征结果比较[M(P25，P75)/n(%)]
影像学特征 SMARCA4-dNSCLC(n＝10) SMARCA4-UT(n＝27) Z/χ2值 P值
部位[n(%)]     5.672 0.705
左上叶 2(20.00) 5(18.52)    
左下叶 1(10.00) 4(14.81)    
右上叶 3(30.00) 9(33.33)    
右中叶 0(0.00) 2(7.41)    
右下叶 3(30.00) 2(7.41)    
胸膜 0(0.00) 1(3.70)    
纵隔 1(10.00) 1(3.70)    
肺门 0(0.00) 3(11.11)    
肿瘤大小(cm)[M(P25，P75)] 4.10(2.86，5.68) 6.02(4.50，7.20) －2.190 0.028
肿瘤密度[n(%)]     8.826 0.006
不均匀 3(30.00) 22(81.48)    
均匀 7(70.00) 5(18.52)    
强化均匀度[n(%)]     7.554 0.012
不均匀 4(40.00) 24(88.89)    
均匀 6(60.00) 3(11.11)    
表3 两者的分期、远处转移情况及Ki-67增殖指数比较[n(%)]
观察指标 SMARCA4-dNSCLC(n＝10) SMARCA4-UT(n＝27) t/χ2值 P值
TNM临床分期[n(%)]     10.680 0.010
Ⅰ期 3(30.00) 0(0.00)    
Ⅱ期 1(10.00) 1(3.70)    
Ⅲ期 3(30.00) 7(25.93)    
Ⅳ期 3(40.00) 19(70.37)    
转移部位[n(%)]        
远处淋巴结 1(10.00) 10(37.04) 2.553 0.224
纵隔 4(40.00) 22(81.48) 6.010 0.038
肺门 3(30.00) 13(48.15) 0.979 0.461
双肺 0(0.00) 6(22.22) 2.652 0.162
胸膜 1(10.00) 5(18.52) 0.390 1.000
心包 0(0.00) 3(11.11) 1.209 0.548
肝脏 1(1.00) 4(14.81) 0.145 1.000
肾上腺 0(0.00) 5(18.52) 2.141 0.295
颅脑 0(0.00) 3(11.11) 1.209 0.548
骨 2(20.00) 5(18.52) 0.010 1.000
包绕血管 0(0.00) 4(14.81) 1.661 0.557
Ki-67增殖指数[n(%)]     6.512 0.021
<50% 5(50.00) 3(11.11)    
Ki-67 ≥ 50% 5(50.00) 24(88.89)    
图2 SMARCA4-dNSCL与SMARCA4-UT HE染色及免疫组化；图A为SMARCA4-dNSCL肿瘤细胞体积比较大，胞浆丰富，保留上皮样结构；图B为SMARCA4-dNSCL免疫组化示SMARCA4蛋白表达缺失；图C为SMARCA4-UT肿瘤细胞上皮分化极少，呈弥漫成片状分布，细胞之间的黏附性差，部分呈巢状排列，细胞核异型性明显，核仁显著，核分裂象易见，肿瘤生长活跃。(HE染色×200)；图D为SMARCA4-UT免疫组化示SMARCA4蛋白表达缺失
图3 两者KaplanMeier生存曲线比较；SMARCA4-dNSCLC为胸部SMARCA4缺失型非小细胞肺癌；SMARCA4-UT为SMARCA4缺失型未分化肿瘤
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