肺癌脊柱转移瘤患者的流行病学特点研究

Epidemiological characteristics of lung cancer patients with spinal metastases

目的:多中心分析肺癌脊柱转移瘤患者的流行病学特点。方法:选取2006年3月~2019年9月国内6家临床医学中心住院治疗的肺癌脊柱转移瘤患者,采用查阅病历、电话随访、门诊随访的方式,统计患者性别、年龄、住院时间、吸烟史、肿瘤组织学分型、脊柱转移节段和数目、其他转移情况、神经功能Frankel分级、身体状况KPS评分,以及是否手术、放疗、化疗以及靶向药物治疗等情况。以每10年为一个界限划分年龄组,并将肿瘤分成小细胞肺癌和非小细胞肺癌,非小细胞肺癌进一步划分为腺癌、鳞癌、腺鳞癌、大细胞癌和未定分型肺癌。分析年龄、性别与肿瘤亚型的关系,脊柱转移的节段和频次、内脏转移频次、神经功能和一般状况、手术和预后评分的关系等。结果:共收集肺癌脊柱转移者811例,其中明确病理类型的541例纳入研究,男性313例,年龄58.8±29.9(32~75)岁;女性228例,年龄56.7±29.1(28~72)岁,男女间的年龄无明显差异(P>0.05)。50~59岁和60~69岁肿瘤发病率最高,占36.04%和36.41%。组织学分型中非小细胞肺癌499例(92.24%),小细胞癌28例(5.18%);其他14例(2.59%)。非小细胞肺癌中腺癌432例(79.85%),鳞癌47例(8.69%),腺鳞癌3例(0.55%),大细胞癌1例(0.18%),未定型非小细胞肺癌16例(2.96%)。腺癌在男性和女性间的发病率无明显差异(P>0.05),小细胞肺癌和鳞癌中的男性发病率明显高于女性(P<0.05)。吸烟史患者172例(31.79%),无吸烟史患者369例(68.21%),吸烟组患者的鳞癌发生率明显高于非吸烟组(P<0.01);肺癌和脊柱转移瘤同期发现者287例(53%);单纯脊柱转移199例,伴其他骨转移342例。脊柱转移患者中单节段156例,双节段112例,≥3节段273例。脊柱转移频次:颈椎105例(9%),胸椎287例(25%),胸腰段239例(20%),腰椎275例(24%),骶椎258例(22%)。184例伴有内脏转移,累计转移288例次,依次为肺内转移69例次,脑转移66例次,肝转移62例次,肾上腺39例次等。Frankel脊髓损伤分级A级12例,B级9例,C级31例,D级180例,E级309例。KPS评分10~49分26例,50~79分328例,80~100分187例。手术治疗217例(开放手术198例,微创手术19例),Tokuhashi评分5.96±2.02;非手术治疗(放疗、化疗、靶向药物治疗)324例,Tokuhashi评分5.65±1.96;手术与非手术组Tokuhashi评分无明显差异(P>0.05)。手术组共计21例(9.68%)按照Tokuhashi评分≥9分有手术指征,有199例(91.71%)按照Uei评分≥3分有手术指征。结论:肺癌脊柱转移瘤以50~69岁高发,腺癌是其最常见的病理类型,胸腰椎是脊柱转移的好发部位;手术指征主要参考患者的脊髓功能和身体状况,与Tokuhashi评分无明显相关性。

Objectives:To study the epidemiological characteristics of spinal metastasis secondary to lung cancer in several nationwide medical centers.Methods:From March 2006 to September 2019,data of spinal metastases secondary to lung cancer in six Chinese medical centers were recorded.Using medical records,telephone follow-up,outpatient follow-up,to collect the patients′gender,age,length of hospital stay,smoking history,tumor credits,transferring the segmental spinal and number,the other transfer situation,nerve function Frankel classification,KPS score,physical condition and whether surgery,radiotherapy,chemotherapy and targeted drug therapy.The age group was bounded by every 10 years.The pathologic types divided into small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC),NSCLC was further divided into adenocarcinoma,squamous cell carcinoma,adenosquamous cell carcinoma,large cell carcinoma and unclassified lung cancer.The relationship between age,sex and tumor subtypes,the level and frequency of spinal metastasis,the frequency of visceral metastasis,the relationship between neurological function and general condition,surgery and prognosis score were analyzed.Results:A total of 811 patients with lung cancer of spinal metastases were collected.Finally 541 cases with histological diagnosis were enrolled in this study including 313 males and 228 females.The mean age of male and female was 58.8±29.9(32-75)years old and 56.7±29.1(28-72)years old respectively.The morbidities of 50 to 69 years old and 60 to 69 years old were higher than other age groups which accounting for 36.04 percent and 36.41 percent,respectively.Histologic type of NSCLC was 499 cases(92.24%),SCLC was 28 cases(5.18%),others was 14 cases(2.59%).In NSCLC,432 cases(79.85%)of adenocarcinoma,47 cases(8.69%)of squamous cancer,3 cases(0.55%)of adenosquamouscarcinoma,1 case of large cell carcinoma(0.18%),16 cases of unidentified NSCLC(2.96%).Compared between men and women,there was no significant difference in the morbidity of adenocarcinoma.However,the morbidities of small cell lung cancer and squamous carcinoma of male group were significantly higher than female group(P<0.05).172 cases of patients with a history of smoking and 369 cases without,the incidence of squamous cancer was significantly different between the two groups(P<0.01).53%cases of lung cancer and spinal metastasis were diagnosed simultaneously.Osseous metastasis:199 cases affected spine alone,other 342 cases were concomitant with other bone metastases;Spine metastases:156 cases involved one segment,112 cases involved two segments,and 273 cases involved more than three segments.Frequency of spinal metastases:cervical spine in 105 cases(9%),thoracic spine in 287 cases(25%),thoracolumbar spine in 239 cases(20%),lumbar spine in 275 cases(24%),sacral spine in 258 cases(22%).Visceral metastases were identified in 184 cases(34%)with a total of 288 metastatic cites,which were intrapulmonary metastasis in 69 cases,66 brain metastases,62 liver and 39 adrenal glands metastases.Frankel spinal cord injury classifications:grade A in 12 cases,grade B in 9 cases,grade C in 31 cases,grade D in 180 cases,and grade E in 309 cases.KPS scores:10 to 49 points in 26 cases,50 to 79 points in 328 cases,80 to 100 points in 187 cases.217 cases underwent surgery including 198 open procedures and 19 cases of percutaneous vertebroplasty or kyphoplasty.324 cases underwent non-invasive treatment(radiation,chemotherapy,targeted drug therapy).The mean Tokuhashi scores of patients underwent surgery or not was 5.96±2.02 and 5.65±1.96,respectively.No differences were found between the two groups(P<0.05).There were 21 cases who had surgical indications by Tokuhashi scores criteria of≥9 points.However,199 cases(91.71%)had surgical indications according to Uei scores of≥3 points.Conclusions:The highest morbidities of lung cancer with spinal metastasis are between 50 to 69 years old.Adenocarcinoma is the most common histologic typ;thoracic and lumber spine is the highest affected location.Patient′s neurological status and physical condition are the most concern for surgery by orthopedic surgeons.