Duan Jianchun, Liu Xuyi, Wang Jie, Zhao Jun, Wu Meina, Fang Jian, Yang Lu, An Tongtong, Guo Qingzhi
Department of Thoracic Tumor, Beijing University School of Oncology, Beijing Cancer Hospital, Beijing 100036, P.R.China.
Zhongguo Fei Ai Za Zhi. 2006 Dec 20;9(6):530-5. doi: 10.3779/j.issn.1009-3419.2006.06.11.
It is well known that more than 40% patients were initially diagnosed with advanced non-small cell lung cancer (NSCLC) with intrapulmonary or/and distant metastasis. However, up to now, the reports about effects of different metastatic sites on survival were limited. The aim of this study is to investigate the clinicopathologic and survival difference by retrospective analysis among sole intrapulmonary metastasis, sole extrathoracic distant metastasis and simultaneous metastasis of lung and other extrathoracic organs for the patients with advanced NSCLC, and to analyze the prognosis-related factors of NSCLC with intrapulmonary metastasis.
Of the 425 patients with stage IV NSCLC diagnosed by pathology and through staging evaluation and treated at Beijing Cancer Hospital with long follow-up during Oct. 1995 to Dec. 2003, 81 cases had sole intrapulmonary metastasis, 98 cases had sole extrathoracic distant metastasis and 68 cases presented simultaneous lung metastasis and extrathoracic spread. Kaplan-Meier survival curve was performed to estimate the survival of patients with different metastasis, Log-Rank test was used to compare their survival difference, and univariate analysis was used to find prognostic related factors.
Median survival time (MST) and 1-, 2-, 3-year survival rate (SR) for patients with sole intrapulmonary metastasis were 13 months (95% CI: 11-15), 57%, 21%, 7%, respectively; MST was 22 months (95% CI: 18-26) for patients with N1 and/or N2 and 10 months (95%CI: 7-13) for patients with N3 (P=0.001). Among the patients with ipsilateral, contralateral and bilateral intrapulmonary metastasis, difference of MST and 1-, 2-, 3-year SR had no statistical significance (P > 0.05); Survival of patients with sole intrapulmonary metastasis was not significantly different from that of patients with sole brain or bone metastasis (P > 0.05), but was longer than that of patients with simultaneous lung and extrathoracic spread (P=0.021). One way analysis of variance showed that no significant association were found among age, pathologic subtype, differentiation degree or response of first-line chemotherapy and survival of the patients with sole intrapulmonary metastasis (P > 0.05), but sex and invasive status of lymph node (N1/N2 vs N3) were found to influence the survival of the patients (P= 0.018, P=0.001). Further stratified analysis by age showed that invasion of lymph node was independent prognostic factor (P=0.002); whereas for the patients with simultaneous metastasis of lung and distant organs, metastatic numbers (2 vs ≥3) of organ were independent prognostic factor (P=0.013).
No statistical difference is found among survival of NSCLC patients with sole intrapulmonary metastasis and with sole brain, bone metastasis. Invasive status of lymph node and metastatic number of organ are important prognostic factors for patients with sole intrapulmonary metastasis and simultaneous metastasis of lung and extrathoracic organs, respectively.
众所周知，超过40%的患者最初被诊断为伴有肺内或/和远处转移的晚期非小细胞肺癌（NSCLC）。然而，到目前为止，关于不同转移部位对生存影响的报道有限。本研究的目的是通过回顾性分析，探讨晚期NSCLC患者单纯肺内转移、单纯胸外远处转移以及肺和其他胸外器官同时转移之间的临床病理和生存差异，并分析肺内转移NSCLC的预后相关因素。
1995年10月至2003年12月在北京肿瘤医院经病理诊断、分期评估并接受长期随访治疗的425例IV期NSCLC患者中，81例为单纯肺内转移，98例为单纯胸外远处转移，68例为肺转移和胸外扩散同时存在。采用Kaplan-Meier生存曲线评估不同转移患者的生存情况，Log-Rank检验比较其生存差异，单因素分析寻找预后相关因素。
单纯肺内转移患者的中位生存时间（MST）及1年、2年、3年生存率（SR）分别为13个月（95%CI：11 - 15）、57%、21%、7%；N1和/或N2患者的MST为22个月（95%CI：18 - 26），N3患者的MST为10个月（95%CI：7 - 13）（P = 0.001）。在同侧、对侧及双侧肺内转移患者中，MST及1年、2年、3年SR的差异无统计学意义（P > 0.05）；单纯肺内转移患者的生存与单纯脑转移或骨转移患者无显著差异（P > 0.05），但长于肺和胸外同时转移患者（P = 0.021）。单因素方差分析显示，单纯肺内转移患者的年龄、病理亚型、分化程度或一线化疗反应与生存无显著关联（P > 0.05），但性别和淋巴结浸润状态（N1/N2与N3）影响患者生存（P = 0.018，P = 0.001）。进一步按年龄分层分析显示，淋巴结浸润是独立预后因素（P = 0.002）；而对于肺和远处器官同时转移的患者，器官转移数量（2个与≥3个）是独立预后因素（P = 0.013）。
单纯肺内转移的NSCLC患者与单纯脑转移、骨转移患者的生存无统计学差异。淋巴结浸润状态和器官转移数量分别是单纯肺内转移患者及肺和胸外器官同时转移患者的重要预后因素。
