非小细胞肺癌首发骨转移患者的临床特征、治疗及预后分析

doi:10.3969/j.issn.1006-7795.2015.04.004

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (4): 533-536.doi: 10.3969/j.issn.1006-7795.2015.04.004

非小细胞肺癌首发骨转移患者的临床特征、治疗及预后分析

姚舒洋, 王鑫, 李小雪, 张毅, 支修益

首都医科大学宣武医院胸外科, 北京 100053

收稿日期:2015-05-28 出版日期:2015-08-21 发布日期:2015-07-17
通讯作者: 支修益 E-mail:xiuyizhi@aliyun.com
基金资助:
首都医学发展科研基金(2009-2085)。

Pattern of bone metastasis and treatment of Chinese patients with advanced non-small-cell lung cancer

Yao Shuyang, Wang Xin, Li Xiaoxue, Zhang Yi, Zhi Xiuyi

Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Received:2015-05-28 Online:2015-08-21 Published:2015-07-17
Supported by:
This study was supported by Scientific Research Foundation of Capital Medical Development(2009-2085).

摘要/Abstract

摘要：

目的探讨晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)首发骨转移患者的临床特征、治疗及预后。方法收集2010年7月至2013年12月首都医科大学宣武医院肺癌中心诊治的103例晚期NSCLC首发骨转移患者的资料,回顾性分析其临床特点,探讨不同治疗策略和临床因素对预后的影响。结果患者年龄为59(32~82)岁,其中,单纯骨转移患者28例,其他患者均合并其他部位侵犯。NSCLC骨转移多为溶骨性病变(95.1%)。其骨相关事件发生率仅为21.4%。单纯骨转移患者预后优于合并内脏器官转移的骨转移患者(P=0.048),中位总生存期分别为18个月和14个月。NSCLC骨转移患者采用的治疗多为全身化学治疗(以下简称化疗),一线化疗比例为77.7%。一线化疗有效率为32.5%,临床获益率为58.8%。一线化疗和一线靶向治疗的疾病无进展时间TTP分别为5个月和10个月,两者比较,差异有统计学意义(P=0.000)。结论 NSCLC单纯骨转移患者预后优于骨转移合并内脏转移者,给予NSCLC骨转移患者个体化的全身治疗能有效改善患者预后。

关键词: 非小细胞肺癌, 骨转移, 一线治疗, 预后

Abstract:

Objective To investigate the characteristics of bone metastasis, prognosis and treatment strategies of non-small cell lung cancer(NSCLC) patients in China. Methods Totally 103 metastatic NSCLC patients with bone as the first metastatic organ seen between July 1, 2010 and Dec. 31, 2013 were retrospectively reviewed. Clinical pathologic characteristics and treatment outcomes were evaluated in the 103 cases. Results Median age of the patients was 59(32~82) years. Among them, 28 patient had bone metastasis as the only relapse site and the remaining were accompanied by involvement of other locations. Most bone metastases(95.1%) were osteolytic. Overall survival of NSCLC bone metastases without visceral metastases was significantly longer than bone metastases with visceral metastases(18 months vs 14 months, P=0.048). Most NSCLC bone metastases(77.7%) were treated with chemotherapy, the response rate was 32.5%, and the clinical benefit rate was 58.8%. In terms of time to progression, there was significant difference between patients who received first-line chemotherapy and those who received the first-line targeted therapy(P=0.000). Conclusion Patients just with bone metastases had better prognosis than bone metastases patients with visceral metastases. Patients with bone metastases should receive individualized anti-cancer treatment.

Key words: non-small cell lung cancer, neoplasm metastasis, the first-line therapy, prognosis

中图分类号:

R734.2

姚舒洋, 王鑫, 李小雪, 张毅, 支修益. 非小细胞肺癌首发骨转移患者的临床特征、治疗及预后分析[J]. 首都医科大学学报, 2015, 36(4): 533-536.

Yao Shuyang, Wang Xin, Li Xiaoxue, Zhang Yi, Zhi Xiuyi. Pattern of bone metastasis and treatment of Chinese patients with advanced non-small-cell lung cancer[J]. Journal of Capital Medical University, 2015, 36(4): 533-536.

参考文献

[1] Kim S T, Uhm J E, Lee J, et al. Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy[J]. Lung Cancer, 2012,75(1):82-88.
[2] Roato I, Gorassini E, Buffoni L, et al. Spontaneous osteoclastogenesis is a predictive factor for bone metastases from non-small cell lung cancer[J]. Lung Cancer, 2008,61(1):109-116.
[3] De Marinis F, Eberhardt W, Harper P G, et al. Bisphosphonate use in patients with lung cancer and bone metastases: recommendations of a European expert panel[J]. J Thorac Oncol, 2009,4(10):1280-1288.
[4] Coleman R E. Metastatic bone disease: clinical features, pathophysiology and treatment strategies[J]. Cancer Treat Rev, 2001,27(3):165-176.
[5] Rosen L S, Gordon D, Tchekmedyian N S, et al. Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial[J]. Cancer, 2004,100(12):2613-2621.
[6] Iordanidou L, Trivizaki E, Saranti S, et al. Is there a role of whole body bone scan in early stages of non small cell lung cancer patients[J]. J BUON, 2006,11(4):491-497.
[7] Cetin K, Christiansen C F, Jacobsen J B, et al. Bone metastasis, skeletal-related events, and mortality in lung cancer patients: a Danish population-based cohort study[J]. Lung Cancer, 2014,86(2):247-254.
[8] Machado M, Cruz L S, Tannus G, et al. Efficacy of clodronate, pamidronate, and zoledronate in reducing morbidity and mortality in cancer patients with bone metastasis: a meta-analysis of randomized clinical trials[J]. Clin Ther, 2009,31(5):962-979.
[9] 唐顺,郭卫,杨荣利.127例肺癌骨转移患者随访的预后因素分析[J].中国肿瘤临床,2008,35(23):1335-1338.
[10] Mitsudomi T, Morita S, Yatabe Y, et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor(WJTOG3405): an open label, randomised phase 3 trial[J]. Lancet Oncol, 2010,11(2):121-128.
[11] Zhou C, Wu Y L, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer(OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study[J]. Lancet Oncol, 2011,12(8):735-742.
[12] Mok T S, Wu Y L, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma[J]. N Engl J Med, 2009,361(10):947-957.
[13] 何玉明,李良平,张海琳,等.以骨转移症状首发的肺癌临床特征及误诊分析[J].临床误诊误治,2012,25(1):23-26.
[14] 谷耀伟,杨良锁,陈亚丽.单纯化疗与联合唑来膦酸治疗肺癌骨转移疼痛的疗效分析[J].中国煤炭工业医学杂志,2012,15(2):197-198.

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非小细胞肺癌首发骨转移患者的临床特征、治疗及预后分析

Pattern of bone metastasis and treatment of Chinese patients with advanced non-small-cell lung cancer

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