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浸润性腺癌 - 版本历史
2026-04-19T00:33:37Z
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<p>建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面</p>
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<strong>浸润性腺癌</strong>（Invasive Adenocarcinoma, IAC）是[[肺腺癌]]恶性进展的最终阶段，也是非小细胞肺癌（NSCLC）中最常见的组织学亚型。与[[微浸润腺癌]]（MIA）不同，IAC 的肿瘤细胞已突破基底膜，向间质发生广泛浸润，<strong>浸润灶最大径 > 5mm</strong>，并伴有肺泡结构的破坏。IAC 具有高度的异质性，根据其主要生长模式（贴壁、腺泡、乳头、微乳头、实性），其预后差异巨大。此外，IAC 是<strong>[[驱动基因]]</strong>突变（如 EGFR, ALK, ROS1）的高发类型，是[[靶向治疗]]的主要获益人群。<br />
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<div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">浸润性腺癌 (IAC)</div><br />
<div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Invasive Adenocarcinoma (点击展开)</div><br />
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[[Image:Invasive_adenocarcinoma_histology_mixed_subtypes.jpg|100px|IAC病理：腺泡样与实性成分混合]]<br />
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<div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">病理特征：异质性混合生长</div><br />
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<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 40%;">核心定义</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #b91c1c;">浸润深度 > 5 mm</td><br />
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<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">ICD-O 编码</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">8140/3</td><br />
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<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">细胞来源</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[II型肺泡上皮]], [[Clara细胞]]</td><br />
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<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[EGFR]], [[KRAS]], [[ALK]]</td><br />
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<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">恶性标志</th><br />
<td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #b91c1c;">[[微乳头成分]], [[STAS]]</td><br />
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<th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">标准术式</th><br />
<td style="padding: 6px 12px; color: #0f172a;">[[肺叶切除]] + [[淋巴结清扫]]</td><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">病理分级：预后的风向标</h2><br />
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IAC 并非单一疾病，而是多种生长模式的混合体。WHO (2021) 及 IASLC 推荐根据<strong>主要生长模式</strong>及<strong>高级别成分</strong>占比进行三级评分，这直接决定了复发风险：<br />
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<th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%;">分级 (Grade)</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">主要组织学亚型</th><br />
<th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">生物学行为与预后</th><br />
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<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #16a34a;">低级别 (G1)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">[[贴壁生长为主型]] (Lepidic dominant)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>惰性</strong>。复发率极低，接近 MIA。</td><br />
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<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #d97706;">中级别 (G2)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">[[腺泡型]] (Acinar), [[乳头型]] (Papillary)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>中等</strong>。最常见的类型，需警惕淋巴结转移。</td><br />
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<td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600; color: #b91c1c;">高级别 (G3)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;">[[微乳头型]] (Micropapillary), [[实性型]] (Solid)</td><br />
<td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>高侵袭性</strong>。极易发生[[气腔播散]] (STAS) 和远处转移，术后辅助治疗指征更宽。</td><br />
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<strong style="color: #1e40af; display: block; margin-bottom: 10px;">典型的 CT 征象</strong><br />
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<li style="margin-bottom: 8px;"><strong>实性结节：</strong>或实性成分为主的混合磨玻璃结节。</li><br />
<li style="margin-bottom: 8px;"><strong>[[毛刺征]] (Spiculation)：</strong>肿瘤向周围肺组织浸润性生长。</li><br />
<li style="margin-bottom: 8px;"><strong>[[胸膜凹陷征]]：</strong>纤维收缩牵拉胸膜。</li><br />
<li style="margin-bottom: 8px;"><strong>[[充气支气管征]]：</strong>肿瘤包绕支气管，常见于腺癌。</li><br />
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<strong style="color: #1e40af; display: block; margin-bottom: 10px;">关键驱动基因 (亚裔)</strong><br />
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<li style="margin-bottom: 8px;"><strong>[[EGFR]] (~50%)：</strong> 对奥希替尼等 TKI 敏感。</li><br />
<li style="margin-bottom: 8px;"><strong>[[KRAS]] (~10%)：</strong> 传统“不可成药”，现可用 Sotorasib (G12C)。</li><br />
<li style="margin-bottom: 8px;"><strong>[[ALK]] / [[ROS1]] (~5%)：</strong> “钻石突变”，靶向药疗效极佳。</li><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">治疗策略：从手术到全程管理</h2><br />
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<li style="margin-bottom: 12px;"><strong>手术切除 (早期)：</strong> <br />
<br>标准术式为<strong>[[肺叶切除术]]</strong> + 系统性淋巴结清扫。对于直径 < 2cm 且不含微乳头/实性成分的周围型 IAC，JCOG0802 研究支持<strong>[[肺段切除]]</strong>作为替代方案。</li><br />
<li style="margin-bottom: 12px;"><strong>术后辅助 (Adjuvant)：</strong> <br />
<br>对于 IB-IIIA 期切除术后患者，若携带 EGFR 突变，推荐辅助<strong>[[奥希替尼]]</strong>治疗（ADAURA 研究）；若 PD-L1 高表达，可考虑辅助免疫治疗。</li><br />
<li style="margin-bottom: 12px;"><strong>晚期治疗：</strong> <br />
<br>遵循“有靶打靶，无靶免疫+化疗”的原则。</li><br />
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<span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献 [Academic Review]</span><br />
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[1] <strong>Travis WD, et al. (2015).</strong> <em>The 2015 World Health Organization Classification of Lung Tumors.</em> <strong>[[Journal of Thoracic Oncology]]</strong>. <br><br />
<span style="color: #475569;">[点评]：建立了 IAC 的现代病理分类体系，正式废除“混合亚型”术语，强调按主要生长模式（Predominant pattern）进行分类。</span><br />
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[2] <strong>Moreira AL, et al. (2020).</strong> <em>Grading System for Invasive Pulmonary Adenocarcinoma: A Proposal From the International Association for the Study of Lung Cancer Pathology Committee.</em> <strong>[[Journal of Thoracic Oncology]]</strong>. <br><br />
<span style="color: #475569;">[点评]：提出了全新的 IAC 三级评分系统（Grade 1-3），证实了高级别成分（微乳头/实性）即使占比 <20% 也会显著恶化预后。</span><br />
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[3] <strong>Wu YL, et al. (2020).</strong> <em>Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer (ADAURA).</em> <strong>[[New England Journal of Medicine]]</strong>. <br><br />
<span style="color: #475569;">[点评]：改变指南的重磅研究，证实了三代 TKI 辅助治疗可显著延长 EGFR 突变阳性 IAC 患者的无病生存期。</span><br />
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浸润性腺癌 · 知识图谱<br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">组织亚型</td><br />
<td style="padding: 10px 15px; color: #334155;">[[贴壁生长]] • [[腺泡型]] • [[乳头型]] • [[微乳头型]] • [[实性型]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">恶性征象</td><br />
<td style="padding: 10px 15px; color: #334155;">[[气腔播散]] (STAS) • [[胸膜侵犯]] • [[淋巴管癌栓]] • [[神经侵犯]]</td><br />
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<td style="padding: 10px 15px; color: #334155;">[[EGFR]] (19del/L858R) • [[ALK融合]] • [[ROS1]] • [[MET扩增]] • [[RET]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">前沿治疗</td><br />
<td style="padding: 10px 15px; color: #334155;">[[奥希替尼]] • [[SBRT放疗]] • [[辅助化疗]] • [[PD-1抑制剂]]</td><br />
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