晚期小细胞肺癌和非小细胞肺癌不同转移部位预后意义的比较

  目的  明确不同转移部位对小细胞肺癌（small cell lung cancer，SCLC）和非小细胞肺癌（non-small cell lung cancer，NSCLC）预后影响的差异。  方法  回顾性分析天津医科大学肿瘤医院2012年1月至2017年12月确诊为晚期SCLC 266例和2015年1月至2017年12月确诊为晚期NSCLC 275例，总计541例患者病例资料。主要观察指标为总生存期（overall survival，OS）。  结果  在SCLC中，与多器官转移者相比，单器官转移者的预后更好（P=0.000 4）；在NSCLC中，单器官与多器官转移者之间未见到明显的生存差异（P=0.451）。在SCLC单器官转移者中，脑转移的预后相对最好，骨转移的预后相对较差，肝转移的预后最差，三者的中位生存时间（median survival time，MST）分别为14.5、11.5和10.3个月；在NSCLC单器官转移者中，肺内转移的预后最佳，肝和肾上腺转移者的预后较差，三者的MST分别为未达到、7.6和7.3个月。在SCLC多器官转移者中，有骨（P=0.046）、肝（P=0.019）转移者预后较差；而有无脑（P=0.995）、肺（P=0.847）、肾上腺（P=0.255）转移对患者的预后无显著性影响；在NSCLC多器官转移的患者中，有脑（P=0.054）、肾上腺转移（P=0.006）的患者预后较差；有肺（P=0.008）转移的患者预后较好；而有无骨（P=0.091）、肝（P=0.300）转移对患者的预后无显著性影响。  结论  不同转移部位对SCLC和NSCLC预后的影响存在差异。 

Differences in prognosis of site-specific metastases in advanced small cell lung cancer and non-small cell lung cancer

  Objective  To examine the variation in prognosis based on metastatic sites in patients with advanced small cell lung cancer (SCLC) and advanced non-small cell lung cancer (NSCLC).  Methods  In total, 541 patients diagnosed either with advanced SCLC between January 2012 and December 2017 or advanced NSCLC between January 2015 and December 2017 in Tianjin Medical University Cancer Institute and Hospital were included in this retrospective study. The primary endpoint was overall survival (OS).  Results  In SCLC, patients with single-site metastasis had better prognosis than those with multi-site metastases (P=0.000 4). However, there was no significant difference in OS between single-site metastasis and multi-site metastases in NSCLC (P=0.451). Among SCLC patients with single-site metastasis, brain metastases represented the best prognosis[median survival time (MST), 14.5 months], while bone metastases and liver metastases represented the second worst (MST, 11.5 months) and worst (MST, 10.3 months) prognoses, respectively. However, in NSCLC with single-site metastasis, lung metastases revealed the best prognosis (MST, not reached), while liver metastases (MST, 7.6 months) and adrenal metastases (MST, 7.3 months) revealed the poorest prognosis. Among SCLC patients with multi-site metastases, bone metastases (P=0.046) and liver metastases (P=0.019) showed poor prognosis, while brain (P=0.995), lung (P=0.847), and adrenal (P=0.255) metastases showed no significant effect on prognosis. Meanwhile, among NSCLC patients with multi-site metastases, brain metastases (P=0.054) and adrenal metastases (P=0.006) resulted in poor prognosis, while lung metastases (P=0.008) resulted in a better prognosis. However, the presence of bone (P=0.091) and liver metastases (P=0.300) showed no significant effect on prognosis in NSCLC patients with multi-site metastases.  Conclusions  Differential prognostic significance was observed in site-specific metastases in SCLC and NSCLC.