小细胞肺癌骨转移的机制及其诊断标志物的研究进展

Research Progress on the Mechanism and Diagnostic Markers of Bone Metastasis in Small Cell Lung Cancer

小细胞肺癌(small cell lung cancer,SCLC)是一种恶性程度高、转变迅速、侵袭转移快的肺癌亚型,极易出现早期转移,预后较差。SCLC骨转移共经历癌细胞在原发部位增殖并突破局部组织、进入血液循环形成循环肿瘤细胞(circulating tumor cells,CTCs)并通过血液循环到达骨组织、到达骨组织后在骨微环境的支持下生根发芽形成新的肿瘤灶等三大阶段,而传统的影像学、病理学检查具有敏感性低、价格昂贵、实施难度大等缺点,基于血液标志物检测作为SCLC骨转移筛查与疗效评估的探索性研究近年多有报道。本文通过综述SCLC骨转移形成的分子生物学机制,发现SCLC骨转移中影像学及病理活检等常规诊断方法的不足,透明质酸、蛋白质生物标志物、非编码RNA、液体活检中的生物标志物等变化早于影像学变化,具有操作简便、可重复性好等优点,为SCLC骨转移早期诊断提供新思路、新方法,值得在临床推广应用。

Small cell lung cancer(SCLC)is a type of lung cancer with high malignant degree,rapid transformation,rapid invasion and metastasis,which is prone to early metastasis and poor prognosis.Bone metastases of SCLC occur in three stages:cancer cells proliferate at the primary site,break through local tissues,enter the blood circulation to form circulating tumor cells(CTCs),reach bone tissue through blood circulation,and take root and germinate to form new tumor sites with the support of the bone microenvironment.However,traditional imaging and pathology examinations have disadvantages such as low sensitivity,high cost and difficulty in implementation.Exploratory studies based on blood marker detection as screening and efficacy evaluation of SCLC bone metastases have been reported in recent years.By reviewing the molecular biological mechanism of SCLC bone metastasis formation,this paper found that conventional diagnostic methods such as imaging and pathological biopsy were inadequate in SCLC bone metastasis.The changes in hyaluronic acid,protein biomarkers,non-coding RNA,and biomarkers in liquid biopsy were earlier than the changes in imaging,which had the advantages of simple operation and good repeatability.It provides a new idea and method for the early diagnosis of SCLC bone metastasis,which is worthy of clinical application.