肺癌患者骨转移的发生率及后果
Incidence and consequences of bone metastases in lung cancer patients.
作者信息
Kuchuk Michael, Addison Christina L, Clemons Mark, Kuchuk Iryna, Wheatley-Price Paul
机构信息
Division of Medical Oncology, University of Ottawa and The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.
Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Medicine and Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada.
出版信息
J Bone Oncol. 2013 Jan 17;2(1):22-9. doi: 10.1016/j.jbo.2012.12.004. eCollection 2013 Feb.
BACKGROUND
Bone metastases (BM) are common in NSCLC patients. Despite some potential positive effects of bone-targeted therapies, their use in NSCLC is infrequent, which may relate to the overall poor prognosis of advanced lung cancer. We reviewed the literature to evaluate the incidence, consequences and use of bone-targeting agents in lung cancer patients with BM in both the trial and non-trial clinical setting.
METHODS
Published prospective and retrospective papers investigating lung cancer and BM, in trial and non-trial settings, were identified and are discussed in this review.
RESULTS
BM are common in patients with advanced lung cancer and often present symptomatically with pain and skeletal related events (SREs). Patients with high bone turnover marker levels, multiple BM, and history of pathological fractures have shorter overall survival. In randomized studies bone-targeted therapies reduced the risk of SREs and prolonged the time to first SRE. The use of bone-targeted agents may also be associated with a survival benefit.
CONCLUSION
BM are a common problem in advanced lung cancer. While the benefits of bone-targeted therapies have been demonstrated, their use is limited in non-trial populations. If better predictive markers of individual risk were available this might increase the appropriate use of bone-targeted agents.
背景
骨转移（BM）在非小细胞肺癌（NSCLC）患者中很常见。尽管骨靶向治疗有一些潜在的积极作用，但它们在NSCLC中的应用并不常见，这可能与晚期肺癌总体预后较差有关。我们回顾了文献，以评估骨靶向药物在试验和非试验临床环境中用于肺癌伴BM患者的发生率、后果及应用情况。
方法
检索并在本综述中讨论已发表的在试验和非试验环境下研究肺癌和BM的前瞻性和回顾性论文。
结果
BM在晚期肺癌患者中很常见，常表现为疼痛和骨相关事件（SREs）等症状。骨转换标志物水平高、多发BM及有病理骨折史的患者总生存期较短。在随机研究中，骨靶向治疗降低了SREs的风险，并延长了首次发生SRE的时间。使用骨靶向药物也可能与生存获益相关。
结论
BM是晚期肺癌中的常见问题。虽然骨靶向治疗的益处已得到证实，但其在非试验人群中的应用有限。如果能有更好的个体风险预测标志物，可能会增加骨靶向药物的合理应用。
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