127例肺癌骨转移患者随访的预后因素分析

Prognostic Factors for Patients with Bone Metastasis from Lung Cancer

目的:肺癌是最常出现骨转移的实体肿瘤之一。本研究旨在评估影响肺癌骨转移患者的预后因素。方法:本研究随访1997年10月至2007年1月间北京大学人民医院收治的肺癌骨转移患者127例。其中男84例,女43例;平均年龄61.2岁(29～88岁)。应用X线平片、CT、MRI和全身骨扫描确定骨转移灶的部位及数目。根据病理分(16.5%)。应用Kaplan-Meier生存曲线和COX生存相关模型分析各相关危险因素,找到影响肺癌骨转移患者预后的类将肺癌骨转移分为腺癌转移80例(63.0%),鳞癌转移17例(13.4%),大细胞癌转移9例(7.1%),小细胞癌转移21例各个相关因素。结果:本组患者肺癌骨转移后6个月、1年和2年的累积生存率分别为72.4%、25.8%和8.0%。肺癌患者的中位生存时间为10.6个月,诊断骨转移后的中位生存时间为6.7个月。单因素统计分析显示肺癌骨转移后影响生存的有效预后因素包括患者的一般生存状态、肿瘤的病理类型、转移灶数目(单发或多发)、以骨破坏为首诊症状、有无其它脏器转移、转移时长(从诊断肺癌到出现骨转移的时间间隔)、是否存在骨科并发症(病理性骨折或脊髓压迫)。多因素统计分析显示肺癌骨转移后影响生存的有效预后因素包括患者的一般生存状态、肿瘤的病理类型、转移灶数目、有无其它脏器转移、转移时长。结论:明确肺癌骨转移患者的预后因素有助于确定手术的适应证,进一步提高肺癌骨转移患者的治疗效果和生存期。

Objective： Lung cancer is one of the most common solid tumors that metastasizes to bone. The aim of this study was to assess prognostic factors of patients with bone metastasis from lung cancer. Methods： We followed up 127 patients with bone metastases from lung cancer seen in our hospital during October 1997 and January 2007. There were 84 males and 43 females with an average age of 61.2 years. Plain radiographs, CT, MRI and bone scintigraphy were used for detection of bone metastases. Based on pathologic study, tumors were histologically identified as adenocarcinoma in 80 patients （63.0%）, squamous cell carcino- ma in 17 patients （13.4%）, large cell carcinoma in 9 patients （7.1%）, and small cell carcinoma in 21 patients （16.5%）. We used Kaplaneier survival curve and Cox comparative hazards model to analyze prognostic factors. Several predictors of survival have been identified. Results： The 6-month and 1- and 2-year cumulative survival rates after bone metastasis from lung cancer were 72.4%, 25.8%, and 8%, respectively. The median survival time of these patients was 10.6 months, and the median survival time after the diagnosis of bone metastasis was 6.7 months. Univariate analysis showed that the significant prognostic factors for survival of lung cancer patients with bone metastasis included patients＇ survival state, tumor subtype, the number of metastatic foci, bone destruction, visceral metastases, the interval between the diagnosis of lung cancer and bone metastasis, .presence of skeletal complications （pathologic fracture or spinal cord compression）. Multivariate analysis showed that the significant prognostic factors included patients＇ survival state, tumor sub- type, the number of metastasis foci （isolated or multiple）, visceral metastases, and interval between the diagnosis of lung cancer and bone metastasis. Conclusion： The prognostic factors for survival are useful for determining the optimal surgical method, and they are valuable for improving the survival of lung cancer patients with bone metastases.