322例广泛期SCLC不同转移部位的生存分析

doi:10.3760/cma.j.issn.1004-4221.2017.01.004

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (842 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的探讨广泛期SCLC患者不同转移部位对预后的影响。方法回顾分析本院2011—2015年间收治的经病理学或细胞学诊断的广泛期SCLC患者322例,其中原发病灶伴远处器官转移246例,原发病灶伴非区域淋巴结转移76例。转移累及单器官261例,累及多器官61例。322例患者绝大多数接受EP、CE方案化疗,187例接受胸部3DRT。采用Kaplan-Meier法计算生存率,Logrank法比较组间生存差异,Cox模型多因素预后分析。结果全组中位生存期和1、2年OS分别为11.7个月和47.9%、19.5%;转移累及单器官者分别为12.4个月和52.5%、21.9%,转移累及多器官者分别为8.9个月和30.5%、11.2%(P=0.014)。单器官转移中肝转移预后最差,中位生存期仅为8.5个月,非区域淋巴结转移预后最好,中位生存期为14.5个月(P=0.001);除去肝转移以外单器官转移生存差异无统计学意义(P=0.139)。多器官转移中伴肝转移和伴骨转移预后最差(P=0.016、0.006),而有无脑转移对广泛期SCLC多器官转移患者预后影响不大(P=0.995)。单纯肝转移和多器官转移预后无明显差异(P=0.862)。结论广泛期SCLC患者初诊时单器官转移累及肝脏对预后有影响且预后最差;多器官转移伴肝转移以及伴骨转移预后最差,而有无脑转移对预后影响不大。转移一旦累及肝脏,单器官受累和多器官受累生存无明显差异。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	罗婧
	徐利明
	赵路军
	王煜雯
	庞青松
	王军
	袁智勇
	王平

关键词 ：癌,小细胞肺/放射疗法, 癌,小细胞肺/化学疗法, 远处转移, 预后

Abstract：

Objective To investigate the effects of different metastatic sites on the prognosis of extensive-stage small cell lung cancer (SCLC). Methods A retrospective analysis was performed among 322 patients pathologically or cytologically diagnosed with extensive-stage SCLC (stage ⅠV defined by the seventh edition of the American Joint Committee on Cancer) who were admitted to our hospital from 2011 to 2015. In those patients, 246 had primary lesions with distant metastasis and 76 primary lesions with non-regional lymph node metastasis;261 had single-organ metastasis and 61 multi-organ metastases. Survival rates were calculated using the Kaplan-Meier method. Between-group comparison of the survival was made by the log-rank test. A multivariate prognostic analysis was made by the Cox proportional hazard model. Results In all the patients, the median survival time (MST) was 11.7 months;1-and 2-year overall survival (OS) rates were 47.9% and 19.5%, respectively. The patients with single-organ metastasis had significantly longer MST and significantly higher 1-and 2-year OS rates than the patients with multi-organ metastases (12.4 vs. 8.9 months;52.5% vs. 30.5%;21.9% vs. 11.2%;P=0.014). In the patients with single-organ metastasis, those with liver metastasis had the worst prognosis with a MST of 8.5 months, while those with non-regional lymph node metastasis had the best prognosis with a MST of 14.5 months (P=0.001);there was no significant difference in the prognosis between patients with metastasis to different organs other than the liver (P=0.139). In the patients with multi-organ metastases, those with liver metastasis and bone metastasis had the worst prognosis (P=0.016,0.006);there was no significant relationship between brain metastasis and the prognosis of extensive-stage SCLC with multi-organ metastases (P=0.995). There was no significant difference in the prognosis between those with liver metastasis only and multi-organ metastases (P=0.862). Conclusions Liver metastasis predicts the worst prognosis in patients initially diagnosed with extensive-stage SCLC and single-organ metastasis. Liver metastasis and bone metastasis predict the worst prognosis in patients with multi-organ metastases. Brain metastasis has no significant effect on the prognosis. There is no significant difference in the prognosis of extensive-stage SCLC between patients with single-and multi-organ metastases once liver metastasis occurs.

Key words： Carcinoma,small cell lung/radiotherapy Carcinoma,small cell lung/radiotherapy Distant metastasis Prognosis

收稿日期: 2016-04-27

通讯作者: 赵路军,Email:zhaolujun@tjmuch.com

引用本文:

罗婧,徐利明,赵路军等. 322例广泛期SCLC不同转移部位的生存分析[J]. 中华放射肿瘤学杂志, 2017, 26(1): 17-21.

Luo Jing,Xu Liming,Zhao Lujun et al. The survival analysis of different metastasis sites for 332 patients of extensive stage small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(1): 17-21.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.01.004 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I1/17

[1] Yip D,Harper PG.Predictive and prognostic factors in small cell lung cancer:current status[J].Lung Cancer,2000,28(3):173-185.DOI:10.1016/S0169-5002(00)00105-7.
[2] Parikh M,Riess J,Lara PN Jr. New and emerging developments in extensive-stage small cell lung cancer therapeutics[J].Curr Opin Oncol,2016,28(2):97-103.DOI:10.1097/CCO.0000000000000264.
[3] 何燕燕.晚期非小细胞肺癌不同转移器官的特征和预后及基于基因和肿瘤转移负荷的M分期建议[D].广州:南方医科大学,2014.
He YY.Characteristics and prognosis of different metastatic organ site and proposal for the revision of M descriptors based on genotype and metastatic tumor burden in advanced NSCLC[D].Guangzhou:Southern Medical University,2014.
[4] Li XX,Li RJ,Zhao LJ,et al. Expression of molecular factors correlated with metastasis in small cell lung cancer and their significance[J].Int J Clin Exp Pathol,2015,8(11):14676-14684.
[5] 李瑞健.小细胞肺癌远处转移预测因子的筛选及骨转移动物模型的建立[D].天津:天津医科大学,2012.
Li JR.Screening the predictive factor about distant metastases and developing the bone metastasis model of small cell lung cancer[D].Tianjin:Tianjin Medical University,2012.
[6] Hirashima T,Suzuki H,Okamoto N,et al. Important factors for achieving survival of five years or more in non-small cell lung cancer patients with distant metastasis[J].Oncol Lett,2014,8(1):327-334.DOI:10.3892/ol.2014.2107.
[7] Fukui T,Itabashi M,Ishihara M,et al. Prognostic factors affecting the risk of thoracic progression in extensive-stage small cell lung cancer[J].BMC Cancer,2016,16(1):197.DOI:10.1186/s12885-016-2222-4.
[8] Wang HL,Ning T,Li M,et al. Effect of endostatin on preventing postoperative progression of distant metastasis in a murine lung cancer model[J].Tumori,2011,97(6):787-793.DOI:10.1700/1018.11097.
[9] Mishima S,Nozaki Y,Mikami S,et al. Diffuse liver metastasis of small-cell lung cancer presenting as acute liver failure and diagnosed by transjugular liver biopsy:A rare case in whom nodular lesions were detected by enhanced ct examination[J].Case Rep Gastroenterol,2015,9(1):81-87.DOI:10.1159/000381140.
[10] 陈筱玲,方健,聂鋆,等.160例老年小细胞肺癌预后多因素分析[J].中国肺癌杂志,2014,17(1):15-23.DOI:10.3779/j.issn.1009-3419.2014.01.03.
Chen XL,Fang J,Nie J,et al. Multivariate analysis of prognostic factors in the eldly patients with small cell lung cancer:a study of 160 patients[J].Chin J of Lung Cancer,2014,17(1):15-23.DOI:10.3779/j.issn.1009-3419.2014.01.03.
[11] Miyaaki H,Ichikawa T,Taura N,et al. Diffuse liver metastasis of small cell lung cancer causing marked hepatomegaly and fulminant hepatic failure[J].Intern Med,2010,49(14):1383-1386.DOI:10.2169/internalmedicine.49.3296.
[12] Ihara N,Yashiro N,Kinoshita T,et al. Diffuse intrasinusoidal liver metastasis of small cell lung cancer causing fulminant hepatic failure:Ct findings-a case report[J].Radiat Med,2001,19(5):275-277.
[13] Al Husaini H,Wheatley-Price P,Clemons M,et al. Prevention and management of bone metastases in lung cancer:a review[J].J Thorac Oncol,2009,4(2):251-259.DOI:10.1097/JTO.0b013e31819518fc.
[14] Coleman RE.Metastatic bone disease:clinical features,pathophysiology and treatment strategies[J].Cancer Treat Rev,2001,27(3):165-176.DOI:10.1053/ctrv.2000.0210.
[15] Karim NA,Bhatt A,Chiec L,et al. Systemic chemotherapy for progression of brain metastases in extensive-stage small cell lung cancer[J].Case Rep Oncol Med,2015,2015:620582.DOI:10.1155/2015/620582.
[16] Cohen-Inbar O,Sheehan JP.Fighting cancer on all fronts:stereotactic radiosurgery and the role for aggressive primary treatment in non-small cell lung cancer patients with one brain metastasis[J].World Neurosurg,2015,83(6):1015-1016.DOI:10.1016/j.wneu.2015.02.035.
[17] Arrieta O,Villarreal-Garza C,Zamora J,et al. Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation[J].Radiat Oncol,2011,6:166.DOI:10.1186/1748-717X-6-166.