Eguchi K, Saijo N, Shinkai T, Sasaki Y, Tamura T, Sakurai M, Oyamada H, Terui K, Fukuma H, Beppu Y
Gan To Kagaku Ryoho. 1987 May;14(5 Pt 2):1696-703.
The incidence and prognosis of patients with bone metastasis in primary advanced lung cancer were studied retrospectively. Between Jan. 1980 and Dec. 1985, 289 cases entered various kinds of chemotherapy protocol studies. Patients with bone metastasis of non-small cell lung cancer (NSC) comprised 44% (86/192), and those with small cell lung cancer (SC) comprised 43% (42/97). Histologically, 48% of adenocarcinoma, 50% of large cell carcinoma and 31% of squamous cell carcinoma showed bone metastasis. 8 percent of NSC bone meta (+) cases had an initial symptom of bone metastasis. Bone scan and bone X-ray were complementary and useful for diagnosis of bone metastasis, and sequential examinations tended to reduce the incidence of false-positive cases. Vertebral column, rib, pelvis and femur were the most common sites. Over 70% of the bone metastasis were in multiple skeletal systems, and 90% showed multiple-site involvement for both NSC and SC. Radiation therapy effectively reduced severe pain but paralysis was hard to control. In very few cases surgical treatment was indicated because of multiple bone metastasis, and systemic dissemination. Bone scan in 12% of SC patients showed apparent improvement with systemic chemotherapy. Among the M1 group of adenocarcinoma, median survival was 9 months in bone (+) cases, 11 months in bone (-) cases, 2 year survival was 8%, and 24%, and 3-year survival 2% and 22%, respectively. Among the bone(+) group and bone(-) group in ED cases of SC, median survival was 10 months vs. 11 months, and 2-year survival rates were both 13%. 22 percent (8/36) of squamous cell carcinomas without bone metastasis showed hypercalcemia (5.5 mEq/l). In patients with advanced lung cancer the major goal of treatment is recovery of the performance status of the patient and the relief of pain. In the case of SC, intensive systemic chemotherapy should be conducted as an adjuvant to local therapy.
对原发性晚期肺癌骨转移患者的发病率和预后进行了回顾性研究。1980年1月至1985年12月期间，289例患者进入各种化疗方案研究。非小细胞肺癌（NSC）骨转移患者占44%（86/192），小细胞肺癌（SC）骨转移患者占43%（42/97）。组织学上，48%的腺癌、50%的大细胞癌和31%的鳞状细胞癌出现骨转移。8%的NSC骨转移阳性病例有骨转移的初始症状。骨扫描和骨X线检查对骨转移的诊断具有互补性且有用，序贯检查倾向于降低假阳性病例的发生率。脊柱、肋骨、骨盆和股骨是最常见的部位。超过70%的骨转移发生在多个骨骼系统，90%的NSC和SC骨转移均表现为多部位受累。放射治疗可有效减轻重度疼痛，但瘫痪难以控制。由于多骨转移和全身播散，很少有病例需要手术治疗。12%的SC患者经全身化疗后骨扫描显示明显改善。在腺癌的M1组中，骨转移阳性病例的中位生存期为9个月，骨转移阴性病例为11个月，2年生存率分别为8%和24%，3年生存率分别为2%和22%。在SC的ED病例中，骨转移阳性组和骨转移阴性组的中位生存期分别为10个月和11个月，2年生存率均为13%。22%（8/36）无骨转移的鳞状细胞癌患者出现高钙血症（5.5 mEq/l）。对于晚期肺癌患者，治疗的主要目标是恢复患者的功能状态和缓解疼痛。对于SC，应进行强化全身化疗作为局部治疗的辅助手段。
