Clinical characteristics and treatment analysis of pulmonary blastoma (PB): a report of 17 cases

Introduction

To summarize the disease characteristics of pulmonary blastoma, analyze related prognostic factors, and share the diagnosis and treatment process.

Methods

This study retrospectively analyzed the clinical data of 17 patients with pulmonary blastoma admitted to Shandong Provincial Hospital from January 1994 to December 2024.

Results

The patients were predominantly middle-aged and elderly males, with clinical manifestations mainly including cough, sputum production, chest tightness, and shortness of breath. Chest CT combined with elevated serum neuron-specific enolase (NSE) may assist in diagnosis. The pathological types were predominantly biphasic, followed by epithelial type and those with unclear subtypes. Tumors were more likely to occur in the right lung, and most were at T4 stage or accompanied by regional lymph node metastasis at the time of diagnosis. The higher the Ki-67 positive cell viability rate, the shorter the survival time. Lobectomy is currently an effective treatment, and postoperative radiotherapy can improve the survival time of some patients. The 5-year survival rate was 29.4%. Cox regression analysis showed that gender and tumor stage T had statistical significance for the prognosis of patients with pulmonary blastoma. Verification via Kaplan-Meier survival curves revealed that the survival time of patients with T4 stage was significantly shorter than that of patients with early-stage disease (Log-rank p=0.011).

Conclusions

Preoperative diagnosis of pulmonary blastoma is challenging, with the biphasic type being the predominant pathological subtype. The advanced stage at the time of diagnosis is a key factor for poor prognosis. There is a significant difference in age between pediatric and adult patients. Tumor stage is a key factor affecting prognosis, and the Ki-67 positivity rate is negatively correlated with survival time. Emphasizing the formulation of treatment strategies based on pathological types and tumor stages can provide a reference for improving the level of diagnosis and treatment.