【摘要】 目的 回顾性分析原发性肺肠型腺癌(PEAC)临床特点，提高诊断准确率及治疗有效性，改善患者预后。方法 收集郑州大学第一附属医院东院区2016年10月至2023年5月收治的23例PEAC患者。回顾性分析患者的临床信息。结果 23例患者中，男9例，女14例，平均(62.87±9.52)岁。Ⅰ～Ⅱ期4例，Ⅲ～Ⅳ期19例。原发病灶主要分布于右肺上叶，9例表现为实变影或斑片影，14例表现为结节肿块影，其中纵隔淋巴结肿大最常见。肺炎型患者均出现呼吸道症状，肿瘤直径较大，远处转移少见;结节肿块型患者呼吸道症状较少，远处转移较多见。23例患者死亡21例，存活2例。5例行手术切除，其中4例均于术后1 a内出现复发转移，3例病情进展死亡; 1例行贝伐珠单抗联合免疫检查点抑制剂治疗，病灶稳定，因肠梗阻死亡; 14例行单纯化疗或以化疗为基础的综合治疗，后因病情进展或不良反应过重死亡;3例自动出院，均因病情进展死亡。与单纯化疗相比，化疗联合抗肿瘤血管药物及化疗联合免疫检查点抑制剂(ICIs)可显著延长患者疾病无进展生存期(PFS)。结论 PEAC临床少见，确诊时分期较晚，侵袭性强，影像主要为结节肿块型，其次为肺炎型表现，手术切除复发率高，晚期应用化疗联合抗肿瘤血管生成药物或化疗联合ICIs可能改善患者预后，具体方案选择尚需大样本临床研究。更多还原

【Abstract】 Objective To retrospectively analyze the clinical characteristics of primary lung enteric adenocarcinoma( PEAC),improve diagnostic accuracy and treatment effectiveness,and improve patient prognosis. Methods Twenty-three patients with PEAC admitted to the First Affiliated Hospital of Zhengzhou University East Campus from October 2016 to May 2023 were collected. Clinical information of patients were retrospectively analyzed. Results Among the 23 patients,there were 9 males and 14 females with an average age of( 62. 87 ± 9. 52) years. There were 4 cases in stages Ⅰ-Ⅱ and 19 cases in stages Ⅲ-Ⅳ． The primary lesions were mainly distributed in the upper lobe of the right lung,with 9 cases showing consolidation or patchy shadows,and 14 cases showing nodular mass shadows,among which mediastinal lymph node enlargement was the most common.Pneumonia type presents with respiratory symptoms,with larger tumor diameter and rare distant metastasis; respiratory symptoms are less common,and distant metastasis is more common in the nodular and mass type. Among the 23 patients,21 died and 2 survived. Five cases underwent surgical resection,of which four cases experienced recurrence and metastasis within one year after surgery,and three cases progressed and died. One case was treated with bevacizumab combined with immune checkpoint inhibitors,and the lesion remained stable. However,the patient died due to intestinal obstruction. Fourteen cases of simple chemotherapy or chemotherapy based comprehensive treatment,but later died due to disease progression or severe adverse reactions. Three cases were discharged automatically and died due to disease progression. Compared with chemotherapy alone,the combination of chemotherapy with anti-tumor vascular drugs and chemotherapy with immune checkpoint inhibitors( ICIs)can significantly prolong the progression free survival( PFS) of patients. Conclusion PEAC is rare in clinical practice,with a late stage of diagnosis and strong invasiveness. The imaging mainly shows nodular mass type,followed by pneumonia type.Surgical resection has a high recurrence rate. Late use of chemotherapy combined with anti-tumor angiogenesis drugs or chemotherapy combined with ICIs may improve patient prognosis. Specific protocol selection still requires large-scale clinical studies.更多还原