标题：恶性血液系统疾病合并肺癌患者的临床特征分析

      作者：张旭昌 1，江曼 1，王婷 2，王莉 3，李建勇 3，田发青 1，吴汉新 3，缪扣荣 3    1.深圳市龙岗区人民医院肿瘤血液科，广东 深圳 518000；2.南京医科大学第一附属医院(江苏省人民医院)肿瘤科，江苏 南京 210009；3.南京医科大学第一附属医院(江苏省人民医院)血液科，江苏 南京 210009

      卷次： 2019年30卷24期

      【摘要】 目的 探讨恶性血液系统疾病合并肺癌患者的临床特点和预后。方法 回顾性分析江苏省人民医院血液内科2009年1月至2018年12月期间经病理确诊为恶性血液系统疾病合并肺癌的26例患者的临床资料及预后情况。结果 十年间共确诊恶性血液系统疾病7 921例，其中合并肺癌者26例，在恶性血液系统疾病中，肺癌发生率为 0.33% (26/7 921)，男女性别比为 2.7：1；首次确诊恶性血液系统疾病至确诊肺癌的中位间隔时间为 36个月(0~223个月)，其中同时性多原发性恶性肿瘤(MPM)占 26.9% (7/26)，异时性MPM占 73.1% (19/26)：6~36个月占38.5% (10/26)，36个月以上占34.6% (9/26)；在异时性MPM中，肺癌在血液系统恶性疾病之前和之后确诊者分别占38.5% (10/26)和34.6% (9/26)；第二原发恶性肿瘤发病年龄在70岁前后的中位生存时间分别为240个月和62个月(Log-rank=3.890，P=0.049<0.05)；同时性MPM和异时性MPM的中位生存时间分别为13个月和103个月(Log-rank=24.696，P<0.01)；两种恶性肿瘤间隔时间少于3年和超过3年的中位生存时间分别为19个月和103个月 (Log-rank=12.396，P<0.01)；除7例同时性肿瘤患者外，第一原发恶性肿瘤放化疗组和非放化疗组患者的中位生存时间分别为62个月和172个月(Log-rank=5.644，P=0.018<0.05)。结论 恶性血液系统疾病合并肺癌患者中，第一原发恶性肿瘤的发病年龄和第二原发恶性肿瘤发病年龄越小预后越好，且两种恶性肿瘤发生的间隔时间越长预后越好；异时性MPM的第一原发肿瘤放化疗的患者预后差。
      【关键词】 多原发性恶性肿瘤；恶性血液系统疾病；肺癌；临床特征；预后
      【中图分类号】 R734.2 【文献标识码】 A 【文章编号】 1003—6350（2019）24—3140—05

Clinical characteristics and prognosis analysis of malignant hematopoiesis patients complicated with lung cancer.ZHANG Xu-chang 1, JIANG Man 1, WANG Ting 2, WANG li 3, LI Jian-yong 3, TIAN Fa-qing 1, WU Han-xin 3, MIAOKou-rong 3.
1. Department of Hematology, Longgang District People's Hospital of Shenzhen, Shenzhen 518000, Guangdong,CHINA; 2. Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial Hospital,Nanjing 210009, Jiangsu, CHINA; 3. Department of Hematology, the First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial Hospital, Nanjing 210009, Jiangsu, CHINA
【Abstract】 Objective To investigate the clinical characteristics and prognosis of malignant hematopoiesis com-bined with lung cancer. Methods The clinical data of 26 patients who admitted to Department of Hematology, JiangsuProvincial Hospital and diagnosed with malignant hematopoiesis combined with lung cancer from January 2009 to De-cember 2018, were retrospectively analyzed. Results From January 2009 to December 2018, 7 921 cases of malignanthematological diseases were diagnosed, including 26 cases with lung cancer (0.33%, 26/7 921). The male/female ratiowas 2.7:1. The mean interval from the first diagnosis of the malignant hematological diseases to the diagnosis of lungcancer was 36 months (0-223 months): with 38.5% (10/26) of 6-36 months and 34.6% (9/26) of more than 36 months,and there were 7 cases (26.9%, 7/26) of concurrent multiple primary malignancy (MPM) and 19 cases (73.1%, 19/26)of heterogeneous MPM. Lung cancer was found and diagnosed before or after malignant hematopoiesis in 10 (38.5%,10/26) and 9 cases (34.6%, 9/26), respectively. The median survival time of the second primary malignant tumor at theage of less or more than 70 years old were 240 months and 62 months respectively (Log-rank=3.890, P=0.049<0.05).The median survival time of concurrent and asynchronous tumors was 13 months and 103 months, respectively(Log-rank=24.696, P<0.01). The median survival time of the two sites malignancies with an interval of less or more than3 years were 19 months and 103 months, respectively (Log-rank=12.396, P<0.01). Excluding 7 patients with concurrenttumor, the median survival time was 62 months and 172 months, respectively, by radiochemotherapy or not (Log-rank=5.644, P=0.018<0.05). Conclusion In the malignant hematopoiesis patients complicated with lung cancer, the smallerthe age of the first and second primary malignancies, the better the prognosis, and the longer the interval between thetwo malignancies, the better the prognosis. The prognosis of the first primary tumor of heterochronous MPM was poorafter radiochemotherapy.
      【Key words】 Multiple primary malignancy (MPM); Malignant hematopoiesis; Lung cancer; Clinical characteris-tics; Prognosis