The clinical analysis of pulmonary lymphoepithelioma-like carcinoma with epithelioid granuloma.
The clinical analysis of pulmonary lymphoepithelioma-like carcinoma with epithelioid granuloma.
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肺淋巴上皮瘤样癌伴上皮样肉芽肿的临床分析
DOI：
10.21037/tcr.2019.12.87
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发表时间：
2020-03
影响因子：
0.9
通讯作者：
Qin Y
中科院分区：
文献类型：
--
作者：
Gao G;Zhou C;Wu G;Guan W;Deng G;Zhu Z;Lin X;Xie X;Xie Z;Zhang J;Ouyang M;Zhong N;Li S;Qin Y
背景肺淋巴上皮瘤样癌（PLELC）是一种与 Epstein-bar 病毒（EBV）感染相关的罕见非小细胞肺癌亚型。上皮样肉芽肿 (EG) 的报道较少，且经常被误诊。方法收集2013年1月至2019年10月的数据。在227例诊断为PLELC的患者中，22例患者患有EG。我们分析了 PLELC 患者的临床特征、病理特征和治疗，并对合并或不合并 EG 的 PLELC 患者进行了比较。结果 22例患者并发EG（9.6%）。中位年龄为 50 岁（38-67 岁）。女性多于男性（1.4：1）。大多数患者（68.2%）处于早期阶段，表现非特异性，缺乏Rich-Lewis现象。与205例未并发EG的患者相比，年龄（t=0.938，P=0.349）、性别（χ2=0.898，P=0.343）、初始症状（χ2=2.684，P=0.443）、吸烟状况（χ2=0.210，P=0.647）、肿瘤直径（t=0.993，P=0.647）差异均无统计学意义。 P=0.332）和表现状态（H=0.971，P=0.615）。 EG 通常位于肿瘤内部或邻近肿瘤（71.4%）。特异性染色呈阴性，而 EBV 编码 RNA 的原位杂交染色始终呈阳性。大多数合并EG的患者接受了包括手术、新辅助/辅助化疗或姑息化疗在内的多学科治疗，没有接受抗结核治疗。与205例未并发EG的患者相比，肿瘤分期、DFS（中位，未达到，P=0.914）、PFS（中位，12.3个月，P=0.848）、OS（中位，未达到，P=0.737）以及抗肿瘤治疗和抗结核治疗等治疗均无显着差异。随访14.6个月（范围2.1～94.7个月），无论是否开始抗结核治疗，均未出现结核病发生、进展或复发。结论 PLELC合并EG与不合并EG的患者相比，缺乏Rich-Lewis现象，缺乏特异性的临床特征。 EG可能是由对肿瘤细胞的免疫超敏反应或EBV感染引起的，但不是肺结核。 PLELC合并EG可采用化疗和手术治疗。然而，抗结核治疗是不必要的。
Background Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare subtype of non-small cell lung cancer associated with Epstein-bar virus (EBV) infection. Epithelioid granuloma (EG) has been more scarcely reported and frequently misdiagnosed. Methods Data were collected from January 2013 to October 2019. Of 227 patients diagnosed as having PLELC, 22 patients had EG. We analyzed their clinical features, pathological characteristics and treatment and a comparison between PLELC patients complicated with or without EG was made. Results Twenty-two patients had complicated with EG (9.6%). The median age was 50 years (38–67 years). There were more females than males (1.4:1). Most patients were at early stage (68.2%) with nonspecific manifestations and lack of Rich-Lewis phenomenon. Compared with the 205 patients complicated without EG, there were no significant difference among age (t=0.938, P=0.349), gender (χ2=0.898, P=0.343), initial symptoms (χ2=2.684, P=0.443), smoking status (χ2=0.210, P=0.647), diameter of tumor(t=0.993, P=0.332) and performance status (H=0.971, P=0.615). EG was often located inside or adjacent to the tumor (71.4%). Specific staining was negative, whereas in situ hybridization staining of EBV-encoded RNA was consistently positive. Most patients complicated with EG received multimodality therapy including surgery, neo-adjuvant/adjuvant chemotherapy or palliative chemotherapy and none of them received anti-TB therapy. Compared with the 205 patients complicated without EG, there were no significant difference among tumor stage, DFS (median, not reached, P=0.914), PFS (median, 12.3 months, P=0.848), OS (median, not reached, P=0.737) and treatment including anti-tumor therapy and anti-TB therapy. During follow-up duration for 14.6 months (range, 2.1–94.7 months), none of the patients had occurrence, progression or relapse of tuberculosis, regardless whether anti-tuberculosis therapy was initiated. Conclusions PLELC complicated with EG was lack of Rich-Lewis phenomenon and specific clinical characteristics compared with those without EG. EG might be caused by immunological hypersensitivity to tumor cells or EBV infection but not pulmonary tuberculosis. PLELC complicated with EG could be treated with chemotherapy and surgery. However, anti-tuberculosis therapy was unnecessary.
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影响因子：
1.7
作者：
Tacyildiz, Nurdan;Ugur, Handan;Sak, Serpil Dizbay
通讯作者：
Sak, Serpil Dizbay
肺淋巴上皮瘤样癌 (LELC) 患者血浆 Epstein-Barr 病毒 DNA 的临床意义
影响因子：
20.4
作者：
Xie, Mian;Wu, Xiaojun;Li, Xiaoxiang
通讯作者：
Li, Xiaoxiang
影响因子：
2
作者：
Shet, Tanuja;Pai, Trupti;Desai, Sangeeta
通讯作者：
Desai, Sangeeta
影响因子：
9.6
作者：
Detterbeck, Frank C.;Boffa, Daniel J.;Tanoue, Lynn T.
通讯作者：
Tanoue, Lynn T.
影响因子：
3.7
作者：
Wang, Ling-Zhi;Goh, Sok-Hwei;Goh, Boon-Cher
通讯作者：
Goh, Boon-Cher