169例初诊肺癌骨转移患者临床特征及预后分析

Clinical characteristics and prognosis of 169 patients with newly diagnosed lung cancer with bone metastases

目的分析初诊原发性肺癌骨转移患者的临床特征及预后影响因素。方法收集初诊为原发性肺癌骨转移患者的临床资料169例。分析肺癌骨转移患者的临床特征,采用Kaplan-Meier法和Log-rank检验进行患者生存情况作单因素分析,采用Cox回归分析方法进行患者生存率的多因素分析。结果所有肺癌骨转移患者中位年龄58岁,男女比例1.5∶1。病理类型腺癌117例最多,其次是鳞癌22例,其他病理类型少见。78.1%的患者为多发骨转移。首诊时即有55.6%的患者存在骨相关事件。原发性肺癌骨转移患者的中位生存期在病理类型、合并其他部位转移、肺部病灶手术治疗、化疗、靶向治疗、锶89治疗及双磷酸盐治疗方面比较,差异均具有统计学意义(均P<0.05)。多因素分析结果显示,化疗和靶向治疗是肺癌骨转移预后的独立影响因子(均P<0.05)。结论肺癌骨转移患者中腺癌及多发骨转移常见,肺癌骨转移患者有无化疗和有无靶向治疗是其独立预后因素。

Objective To investigate the clinical characteristics and prognosis factors of lung cancer with bone metastases. Methods The clinical data of 169 cases of primary lung cancer with bone metastasis were collected. The clinical characteristics of lung cancer with bone metastases were analyzed. Kaplan-Meier method and Log-rank test were used to estimate the survival of patients for univariate analysis, and Cox multivariate regression was used in survival analysis. Results The median age of all patients was 58 years and the male to female ratio was 1.5∶1. The histology of lung cancer included 117 patients with adenocarcinoma, 22 patients with squamous cell carcinoma, and 30 patients with others. Furthermore, 78.1%of patients exhibited multiple skeletal metastases at more than two sites and 55.6% of patients experienced skeletal-related events at the time of diagnosis. Kaplan-Meier analysis demonstrated that patients with adenocarcinoma, non-existing organ metastases, lung surgery, chemotherapy, targeted treatment, 89 Sr treatment or bisphosphonates exhibited significantly longer survival time(all P<0.05). Cox multivariate regression analysis identified chemotherapy and targeted treatment as independent predictors of overall survival(both P<0.05). Conclusions Adenocarcinoma and multiple skeletal metastases are common in lung cancer patients with bone metastases. In lung cancer patients with bone metastases, chemotherapy and targeted treatment are independent predictors of overall survival.