晚期非小细胞肺癌骨转移的骨相关事件及生存分析

Skeletal-related events of skeletal metastases in advanced stage non-small cell lung cancer and survival analysis

目的研究晚期非小细胞肺癌骨转移的骨相关事件（SRE）及其生存分析。方法回顾性研究自2002年2月-2006年1月间我院治疗的230例晚期非小细胞肺癌患者，评价其TNM分期、骨转移的诊断（放射性核素扫描、X线片、MRI、CT及PET-CT检查），比较肺癌不同分期骨相关事件的发生率及生存时间。结果在230例晚期非小细胞肺癌患者中发现骨转移70例（30.4%），其中SRE 35例（15.2%）；Ⅲ期患者骨转移发生率14.7%（14/95）低于Ⅳ期41.5%（56/135），有统计学意义（P〈0.01）；但Ⅲ期患者骨转移合并SRE发生率与Ⅳ期相近，未见统计学意义（P〉0.05）。无骨转移组患者平均存活时间高于有骨转移组，未合并SRE组患者存活时间长于合并SRE组，两组比较差异有统计学意义（P均〈0.01）。结论在晚期非小细胞肺癌的治疗期间，临床上应尽早阻止骨相关事件的发生。

Objective To investigate the clinical impact of skeletal-related events （SRE） in advanced stage non-small cell lung cancer （NSCLC） patients, and to compare differences in the therapeutic outcome between patients with and without skeletal metastases or SRE. Methods We retrospectively investigated the charts of all 230 patients with advanced stage NSCLC between February 2002 and January 2006. We assessed their TNM stage,presence of skeletal metastases （on bone scintigraphy, MRI,PET-CT and plain X-ray films）,and outcome parameters such as SRE and survival. Results A total of 70 patients （30. 4%） were found to have skeletal metastases during their clinical course and 35 patients （50%） out of all 70 patients had SRE. Among 135 stage IV patients,a total of 56 （41%） had skeletal metastases,and 25 of these 56 patients （45%） had SRE. The most common SRE were the need for radiotherapy （34.3%） and hypercalcemia （20%）. Patients with SRE tended to have worse survival, while no significant difference of survival was observed between patients with and without skeletal metastases. Conclusion It seems to be important to prevent SRE during the treatment of advanced stage NSCLC, so further studies evaluating hisphosphonates in combination with chemotherapy are warranted.