非小细胞肺癌骨转移的临床与预后分析

目的:总结非小细胞肺癌骨转移的临床特点,探讨影响其预后的相关因素。方法:总结1999年4月-2006年6月上海市胸科医院住院治疗的174例非小细胞肺癌骨转移患者的临床资料,Kaplan-Meier法估计患者1、2年生存率,单因素分析(Log-rank检验)筛选患者预后的影响因素,多因素分析(COX逐步回归模型)进一步确认独立危险因素。结果:非小细胞肺癌骨转移好发部位依次为胸部(38.1%)、脊柱(32.8%)、骨盆(16.3%)、四肢(8.7%)和颅骨(4.1%),其中肋骨(30.7%)、腰椎(17.3%)、胸椎(13.1%)分列前3位。中位生存时间为10.73个月,Kaplan-Meier生存分析结果显示1年、2年生存率分别为47.1%、17.8%。单因素分析显示:PS评分、骨痛、单纯骨转移、单发骨转移、血清碱性磷酸酶(AKP)、血清乳酸酶(LDH)、CEA水平与预后相关(P<0.05)；多因素分析显示:PS评分、单纯骨转移、单发骨转移为非小细胞肺癌骨转移预后的独立影响因素。结论:非小细胞肺癌骨转移好发于胸部(肋骨)、脊柱(腰椎/胸椎)、骨盆(髂骨)等；PS评分、单纯骨转移、单发骨转移可能对患者预后影响较大。

Clinical and prognostic analysis of bone metastases of non-small-cell lung cancer

Objective:To study the clinical features and prognostic factors of bone metastases of non-small-cell lung cancer.Methods: The clinical data of 174 patients with bone metastases of non-small-cell lung cancer,who were treated in our hospital during April 1999 to June 2006,were retrospectively analyzed.Kaplan-Meier analysis was used to estimate the 1- and 2-year survival rates of patients.Log-rank test was used to screen the factors influencing the survival of patients and Cox regression was used to further confirm the independent factors.Results: The predilection sites of bone metastases of non-small-cell lung cancer were chest (38.1%),spine (32.8%),pelvis (16.3%),extremities (8.7%),and skull (4.1%),with the ribs (30.7%),lumber vertebrae (17.3%),and thoracic vertebra (13.1%) ranking the top three.The median survival time of the 174 patients was 10.73 months; Kaplan-Meier analysis showed that the 1- and 2-year survival rates were 47.1% and 17.8%,respectively.It was also showed that the PS Score,bone pain,asymptomatic bone metastases,solitary bone metastasis,serum AKP,LDH,and CEA were associated with the prognosis of patients (P<0.05).Multivariate analysis showed that PS score,solitary bone metastasis and single bone metastasis were the independent factors of prognosis.Conclusion: The predilection sites of bone metastasis of non-small-cell lung cancer include chest part (ribs),spine (lumber/thoracic vertebrae),pelvis (ilium),etc.PS score,asymptomatic bone metastases,and solitary bone metastasis have great influence on the prognoses of patients.