中文摘要：

目的：探讨肺混合型腺癌（1ungmixed—adenocarcinoma，LMAC）构成中各主要混合亚型不同，临床病理学特点及预后有无差异。方法：收集天津医科大学附属肿瘤医院自2004年1月至2006年12月间，经手术切除、病理证实的肺混合型腺癌202例，重新审阅肿物病理切片，判定其主要混合亚型，并依据2004年WHO最新肺癌组织学分类标准分为五组：细支气管肺泡癌（bronchioloalveolar carcinoma，BAC）组、腺泡样腺癌组、实性腺癌伴黏液产生组、乳头状腺癌组以及黏液腺癌组。回顾性分析临床资料并随访至2009年12月。采用Kaplan—Meier法进行生存分析。结果：统计结果显示五组间在性别、年龄、吸烟状态之间差异无显著性（P〉0．05），与就诊时有无症状、淋巴结转移、N分期、T分期、肿瘤大小、临床分期及术后是否复发转移之间差畀具有显著统计学意义（P〈0．05）。其中乳头状腺癌组淋巴结转移率和术后复发转移率最高。五组的3年生存率依次为78．4％、52．5％、48.3％、47．8％和29．4％，差异具有显著统计学意义（P=0．000）。Kaplan—Meier生存分析表明BAC组预后最好，黏液腺癌组预后最差，其余三组预后介于两者之间。结论：五组间在临床病理因素方面各具特点，且有着不同的临床预后。因此对肺混合型腺癌中主要混合亚型进行判定，对指导临床治疗及有效预测预后具有重要的意义。

英文摘要：

Objective： To compare the clinicopathologic and prognostic factors of the mixed-adenocarcinoma of the lung （ MACL ） among major mixed-subtypes. Methods： Data from 202 MACL patients who underwent surgery between January 2004 and December 2006 were reviewed. The results of the pathological diagnosis were rechecked to make sure the major mixed-subtypes of the tumor were classified correctly. Based on the 2004 WHO histological classification of lung cancer, the cases were divided into 5 groups： the bronchiolo-alveolar carcinoma （ BAC ） group, the acinar carcinoma （ AAC ） group, the solid carcinoma （ SAC ） group, the papillary carcinoma （ PAC ） group and the mucinous carcinoma （ MAC ） group. The Kaplan-Meier method was used for survival analysis. Results： Statistical analysis showed that there was no significant difference in sex, age and smoking history among the 5 groups （ P 〉 0.05 ）, nevertheless, significant difference was in found in the symptoms at clinic visits, lymph node metastasis, N staging, T staging, tumor size, clinical TNM staging, and postoperative recurrence and metastasis among the 5 groups （ P 〈 0.05 ）. The highest rates of nodal metastasis and post-operative recurrence and metastasis were found in the group with papillary adenocarcinoma. The 3-year survival rates were 78.4% for the BAC group, 52.5% for the AAC group, 48.3% for the SAC group, 47.8% for the PAC group and 29.4% for the MAC group, with significant difference （ P = 0.000 ）. Kaplan-Meier survival analysis revealed that the BAC group had the most favorable prognosis, and the MAC group had the poorest, while the other 3 groups were in between. Conclusion： There are distinct clinicopathologic features and different clinical prognosis for the 5 major subtypes of mixed adeno-carcinoma of the lung. Successful diagnosis of the mixed-subtype is critical for guiding clinical treatment and establishing a prognosis.