Abstract:

Objective To analyze the different clinical characteristics between lung cancer patients complicated by obsolete pulmonary tuberculosis with ground-glass opacity (GGO) and with solid nodule (SN) in order to indentify earlier and treat GGO type lung cancer complicated by obsolete pulmonary tuberculosis.Methods Forty-five patients with lung cancer complicated with obsolete pulmonary tuberculosis who were diagnosed in our hospital from January 2008 to February 2018 were selected. The patients with GGO type lung cancer complicated with obsolete pulmonary tuberculosis were divided into research group (“GGO group”, 16 cases). The patients with SN type lung cancer complicated with obsolete pulmonary tuberculosis were divided into control group (SN group, 29 cases). The clinical manifestation, CT scan, operation mode and pathological type of the two groups were analyzed retrospectively. t test was used in the comparison of measurement data and χ ² test was used in the comparison of enumeration data. The difference was statistically significant between the two groups when P less than 0.05.Results (1)Age: The average age in GGO group ((51.0±6.1) years old) was less than that ((59.6±8.4 ) years old) in SN group with significant difference statistically (t=3.58, P<0.001). (2) TB history: The average time of TB history in GGO group ((19.5±2.6) years) was shorter than that ((23.3±3.1) years) in SN group with significant difference statistically (t=4.16, P<0.001). (3) Diagnosis time: The average time of confirm diagnosis in GGO group ((382.0±27.0) days) was longer than that ((9.5±5.1) days) in SN group with significant difference statistically (t=77.69, P=0.000). (4) Regional lymph node metastasis: Local lymph node metastasis was not found in all patients (16,100.0%) in GGO group. However, in SN group, local lymph node metastasis was not found in only 16 cases (55.2%), ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary lymph nodes metastases (N1) in 9 cases (31.0%), and ipsilateral mediastinal and/or subcarinal lymph node metastasis (N2) in 4 cases (13.8%). The differences in two groups were significant statistically (χ ²=9.99, P=0.003). (5) The location relationship between tumor and tuberculosis foci: The foci located in the same lobe in 4 cases (25.0%) and in different lobe in 12 cases (75.0%) in GGO group. The foci located in the same lobe in 18 cases (62.1%) and in different lobe in 11 cases (37.9%) in SN group. The differences in two groups were significant statistically (χ ² =4.28, P=0.038). (6) Pathological types: There were squamous cell carcinoma in 1 case (6.3%), adenocarcinoma 14 cases (87.5%) and large cell carcinoma in 1 case (6.3%) in GGO group. There were squamous cell carcinoma in 12 case (41.4%), adenocarcinoma 15 cases (51.7%) and adenosquamous carcinoma in 2 case (6.9%) in SN group. The differences in two groups were significant statistically (χ ² =6.78, P=0.029). (7) Surgical method: There were lobectomy in 11 cases (68.8%), segmentectomy in 1 case (6.3%), wedge resection in 2 cases (12.5%) and lobectomy plus wedge resection in 2 cases (12.5%) in GGO group. There were lobectomy in all cases (29, 100.0%) in SN group. The differences in two groups were significant statistically (χ ² = 15.66, P=0.000).Conclusion Compared with SN type lung cancer, GGO lung cancer complicated with obsolete pulmonary tuberculosis has no specific clinical manifestations, low age of onset, long diagnosis period, no significant correlation between tumor distribution and tuberculosis foci, no correlation of mediastinal lymph node enlargement and lymph node metastasis, diversity of surgical methods and adenocarcinoma as dominant pathological types. It is a special type of lung cancer complicated with pulmonary tuberculosis.

Key words: Lung neoplasms, Tuberculosis, pulmonary, Comorbidity, Diagnostic imaging, Early diagnosis, Combined modality therapy, Evaluation studies