肺癌不同病理类型与骨转移临床特征相关性研究

摘要

目的 基于肺癌单中心数据库,阐述肺癌骨转移患者的临床特征,分析肺癌不同病理类型与骨转移、骨相关事件及生存期之间的关系.方法 回顾性分析天津医科大学肿瘤医院2010年5月至2012年4月861例肺癌患者的临床资料,采用电话和(或)门诊随访方式,记录患者生存状况及治疗情况,并详细记录随访相关资料.总结分析不同病理类型肺癌骨转移患者的临床特征、骨相关事件发生特征及生存分析,采用逻辑回归分析研究肺癌骨转移的发病风险因素,采用比值比(odds ratios,OR)分析探讨肺癌不同病理类型与肺癌骨转移发病之间的关系.运用x2检验比较肺癌不同病理类型发生骨转移、骨相关事件及同时骨转移等所占比例的差异,采用Kaplan-Meier进行肺癌骨转移患者的生存期分析.结果 本研究共纳入861例肺癌患者,其中293例发生骨转移.本队列随访时间至2017年9月,平均随访时间14.2个月.肺癌各病理类型中,肺腺癌患者骨转移发生率最高(39.14％,173/442),其次依次为其它类型(29.91％,35/117),鳞癌(29.47％,56/190)和小细胞肺癌(25.89％,29/112).本队列中,骨转移最常见的部位是脊柱(59.73％,175/293),其次依次为肋骨(49.15％,144/293),骨盆(20.48％,60/293),股骨(16.38％,48/293)和胸骨(13.99％,41/293).逻辑回归分析表明肺腺癌是肺癌骨转移的发病风险因素(P=0.002).比值比分析结果表明,相较其它病理类型,肺腺癌患者更容易发生骨转移[OR=1.60,95％CI(1.21～2.13)].本队列中,58.36％的肺癌骨转移患者被确诊发生骨相关事件,最常见的骨相关事件是骨转移灶放射治疗(51.88％,152/293),其次依次为病理性骨折(15.02％,44/293),脊髓压迫(6.48％,19/293),转移灶外科手术治疗(4.78％,14/293)和恶性高钙血症(1.71％,5/293).不同病理类型患者骨相关事件发生未见显著差异.本队列骨转移患者的中位生存时间为11.5个月,腺癌患者生存期与非腺癌患者生存期未见显著差异(P=0.111).结论 本研究表明肺腺癌骨转移率为39.14％,肺腺癌是肺癌骨转移的高风险因素,针对肺腺癌患者应行早期骨转移筛查.%Objective Based on lung cancer center database,we analyzed the clinical characteristics of lung patients with bone metastases.The relationship between bone metastases,skeletal-related events,survival time and different pathological subtypes of lung cancer were also evaluated in this study.Methods A total of 861 patients with lung cancer were studied from May 2010 to April 2012 at Tianjin Medical University Cancer Institute and Hospital.As to follow-up situation,patients' survival status and treatment information were collected by telephone follow-up and (or) examinationsin outpatient.The clinical characteristics,skeletal-related events and survival of bone metastaticpatients with different pathological types of lung cancer were analyzed.Logistic regression analysis was used to identify risk factors for bone metastases.The relationship between histological subtypes and the incidence of bone metastases was evaluated using Odds Ratios (ORs).The chi-square test was used to compare the proportion of bone metastases,synchronous bone metastases and SREs among different histological subtypes patients.The overall survivals was evaluated using the Kaplan Meier.Results A total of 861 patients with lung cancerwere enrolled in this study,including 293 cases with bone metastases.The average follow-up of our population was 14.2 months and the last follow-up time was September 2017.Among different pathological types of lung cancer,adenocarcinoma (39.14％,173/442) has the highest incidence of bone metastases,followed by other types (29.91％,35/117),squamous cell carcinoma (29.47％,56/190) and SCLC (25.89％,29/112).Spine (59.73％,175/293) was the most common location site of the bone metastases,followed by the ribs (49.15％,144/293),pelvis (20.48％,60/293),femur (16.38％,48/293) and sternal (16.38％,48/293).Lung adenocarcinoma was a risk factor for bonemetastases (P=0.002).In ORs analyze,adenocarcinoma patients were more likely to develop bone metastases [OR=1.60,95％CI (1.21～2.13)].In our cohort,58.36％of patients with lung cancer had skeletal related events.Among various types of skeletal related events of patients with bone metastases,the most common one was radiotherapy for bone metastases (51.88％,152/293),followed by pathological fractures (15.02％,44/293),spinal cord compression (6.48％,19/293),bone instability requiring surgery (4.78％,14/293) and hypercalcemia (1.71％,5/293).There was no significant difference between different types of skeletal related events.The median survival time of the patients with bone metastases was 11.5 months.There was no significant difference in survival between adenocarcinoma patients and non-adenocarcinoma patients (P=0.111).Conclusion This study suggested that the incidence of bone metastasis in lung adenocarcinoma was 39.14％ and lung adenocarcinoma was a risk factor for bone metastases,which supported early screening and monitoring of bone metastasis in the patients.