以骨转移症状首发的肺癌临床特征及误诊分析

Clinical Features and Misdiagnosis Analysis of Lung Cancer with Symptoms of Bone Metastases as the First Manifestation

目的探讨以骨转移症状首发的肺癌临床特点,分析误诊原因及预后。方法回顾分析我院2001年6月～2010年6月诊治的50例以骨转移症状首发的肺癌临床资料。结果 50例均有骨痛,20例伴神经系统症状,6例发生病理性骨折。骨转移以多发、溶骨性骨破坏为主。本组初诊时误诊46例,误诊率92%,误诊时间3 d～3个月,误诊疾病前3位为腰椎间盘突出症、椎体骨质增生和原发性骨肿瘤。经手术病理确诊46例,细胞学作出恶性肿瘤诊断但未明确分型2例,影像学确诊2例。本组1年生存率为10%,中位生存期为4个月。结论以骨转移症状为首发表现的肺癌以多发性、溶骨性骨破坏为特征,腺癌骨转移发生率高,预后差,误诊率高。临床医生对此应高度重视,以减少误诊。

Objective To discuss the clinical features of lung cancer with symptoms of bone metastases as the first manifestation and analyze misdiagnosis and prognosis factors. Methods The clinical records of 50 lung cancer patients with symptoms of bone metastases as the first manifestation during June 2001 and June 2010 in our hospital were retrospectively analyzed. Results All 50 patients had bone pain, 20 suffered from neurologic symptoms and 6 had pathologic bone fracture. The main clinical features of bone metastases were multiple locations and osteolytic bone destruction. 46 cases were initially misdiagnosed, with a misdiagnosis rate of 92% , and the duration of the misdiagnosis period varied from 3 days to 3 months. The top 3 misdiagnosed diseases were lumbar disc herniation（LDH）, hyperostosis and primary bone tumors. Among the 50 cases, 46 were pathologically diagnosed, 2 were cytological diagnosed as having malignant tumors and 2 were diagnosed by imaging tests. The 1-year survival rate of 50 patients was 10% with a mediam survival time of 4 months. Conclusion The main clinical features of lung cancer with symptoms of bone metastases as the first manifestation are multiple locations, osteolytic bone destruction, and high incidence rate of adenocarcinoma bone metastases. Because of the poor prognosis of bone metastases and high rate of misdiagnosis, clinicians should attach great importance to there features.