小细胞肺癌远处转移的临床特点分析：SEER数据分析

Clinical characteristics of small cell lung cancer with distant metastasis:a SEER-based study

目的研究不同器官转移对小细胞肺癌(SCLC)患者临床预后的影响。方法利用美国监测、流行病学及终点事件(SEER)数据库,经过严格的纳入和排除标准,共纳入2010-2013年10 347例SCLC患者,中位随访时间为4个月,中位年龄为67岁。所有患者在确诊时均有远处转移(M1期),根据骨、脑、肝、肺有无转移将患者分为6组:骨转移组、脑转移组、肝转移组、肺转移组、none组(无上述4个器官转移)和多器官转移(MOM)组(上述4个器官中有任意2个或2个以上器官转移),分析不同器官远处转移对SCLC患者临床预后的影响。结果 MOM为SCLC最常见的转移方式,占32.8%(3 396/10 347);其次为肝转移,占19.0%(1 971/10 347);脑转移占12.1%(1 251/10 347);骨转移占10.0%(1 033/10 347)。SCLC特异性死亡率为:骨转移77.2%(797/1 033),脑转移74.1%(927/1 251),肝转移82.4%(1 625/1 971),肺转移73.4%(504/687),MOM 81.6%(2 770/3 396)。Cox回归分析结果显示,以none组为对照,MOM组和肝转移组具有最高的死亡风险比(HR)[95%置信区间(CI)]分别为1.80(1.66~1.96)和1.69(1.54~1.85),其次为骨转移组和脑转移组,分别是1.24(1.12~1.39)和1.28 (1.16~1.42),P均<0.001。肺转移组具有最低的死亡HR,为1.07(95%CI:0.95~1.21,P=0.27)。结论在SCLC中,多器官转移和肝转移预后最差,特异性死亡率最高,其次为骨转移和脑转移,肺内转移预后相对最好。因此对于SCLC合并远处转移的患者,应根据其不同的转移器官进行不同强度的治疗,对具有肝转移及多器官转移者要强化治疗。

Objective To investigate the effect of different organ metastases on clinical prognosis in patients with small cell lung cancer(SCLC). Methods A total of 10 347 SCLC patients with distant metastases(M1) obtained from the surveillance, epidemiology, and end results(SEER) database between 2010 and 2013 were enrolled in this study. The median duration of follow-up was 4 months and the median age was 67 years. According to metastatic sites, the patients were divided into six groups: bone metastasis group, brain metastasis group, liver metastasis group, lung metastasis group, none group(no metastasis found in the bone, brain, liver or lung) and multi-organ metastasis(MOM) group(2 or more organ metastases found in the bone, brain, liver or lung). The effects of different organ metastases on clinical prognosis in SCLC patients were analyzed. Results MOM was the most common pathway of metastasis, accounting for 32.8%(3396/10 347), followed by liver metastasis(19.0%, 1971/10347), brain metastasis(12.1%, 1251/10347) and bone metastasis(10.0%, 1033/10347). The mortality rates associated with bone, brain, liver and lung metastases and MOM were 77.2%(797/1 033), 74.1%(927/1 251), 82.4%(1625/1 971), 73.4%(504/687), and 81.6%(2 770/3 396), respectively. Compared with the none group, the MOM and liver metastasis groups had higher hazard ratio(HR)95% confidence interval [CI] of 1.80(1.66-1.96) and 1.69(1.54-1.85), respectively, followed by bone and brain metastasis groups with HR(95% CI) of 1.24(1.12-1.39) and 1.28(1.16-1.42)(all P<0.001). Lung metastasis group had a lowest HR(95% CI) of 1.07(0.95-1.21)(P=0.27). Conclusion MOM and liver metastases are associated with the worst prognosis and the highest mortality in SCLC patients, followed by bone, brain and lung metastases. Therefore, for the SCLC patients with distant metastasis, different treatments should be carried out according to involved organs, and treatment should be strengthened in patients with liver metastasis and MOM.