Liang Xiaohong, Cheng Yinan, Zhou Weijun, Ni Jun, Li Yuqing, Feng Gaohua
Department of Pulmonary and Critical Care Medicine, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, No. 4, Kangle Road, Zhangjiagang City, Jiangsu Province, China.
J Oncol. 2021 Jun 15;2021:9999968. doi: 10.1155/2021/9999968. eCollection 2021.
Metastasis is one of the most prevalent causes of death in cancer patients and the lungs are among the organs most commonly affected by metastasis. However, analysis of the incidence and prognosis of lung metastasis (LM) based on primary cancer sites is lacking.
We enrolled cancer patients with LM from the Surveillance, Epidemiology, and End Results (SEER) database. The risk factors for LM were determined using multivariate logistics regression. Forest plots were used to compare the impact of with LM versus without LM alone among different primary caner site subgroups.
Among 1,525,441 cases, 47,537 presented with LM at initial diagnosis. Multivariate logistics regression revealed that male sex, older age, later T/N stage, unmarried status, and lack of insurance were risk factors for LM. The incidence of LM was 11.91% in bone cancer and 11.19% in pancreatic cancer. In terms of the distribution of primary cancers, 19.22% of LMs originated from the colon and rectum, with 11.63% from the kidneys. The median survival for LM cases was 6 months, with the best survival in testicular cancer (19 months) and bone cancer (12 months). Patients with LM had higher hazard ratio (HR) for mortality compared to those without LM, except for those with primary cancer in the brain (=0.09). We stratified patients by primary cancer site, and subgroup analyses showed that LM had a significant negative impact on survival. The most significant was in thyroid cancer (HR = 44.79), followed by melanoma (HR = 24.26), prostate (HR = 16.0), breast (HR = 13.46), endometrial (HR = 12.64), testicular (HR = 12.31), and kidney (HR = 11.33) cancer (all < 0.001).
Patients presenting with LM had higher HR for mortality compared to those without LM, except for those with brain tumor. Clinicians should pay more attention to the occurrence of LM, especially in patients with a significantly increased HR for mortality, such as those with thyroid cancer, melanoma, and prostate cancer.
转移是癌症患者最常见的死亡原因之一，肺部是最常受转移影响的器官之一。然而，基于原发癌部位对肺转移（LM）的发病率和预后进行分析的研究尚属缺乏。
我们从监测、流行病学和最终结果（SEER）数据库中纳入了患有LM的癌症患者。使用多因素逻辑回归确定LM的危险因素。森林图用于比较不同原发癌部位亚组中伴有LM与不伴有LM的影响。
在1,525,441例病例中，47,537例在初次诊断时出现LM。多因素逻辑回归显示，男性、年龄较大、T/N分期较晚、未婚状态和缺乏保险是LM的危险因素。骨癌中LM的发病率为11.91%，胰腺癌中为11.19%。就原发癌的分布而言，19.22%的LM起源于结肠和直肠，11.63%起源于肾脏。LM病例的中位生存期为6个月，睾丸癌（19个月）和骨癌（12个月）患者的生存期最佳。与无LM的患者相比，有LM的患者死亡风险比（HR）更高，但原发性脑癌患者除外（HR = 0.09）。我们按原发癌部位对患者进行分层，亚组分析显示LM对生存有显著的负面影响。影响最显著的是甲状腺癌（HR = 44.79），其次是黑色素瘤（HR = 24.26）、前列腺癌（HR = 16.0）、乳腺癌（HR = 13.46）、子宫内膜癌（HR = 12.64）、睾丸癌（HR = 12.31）和肾癌（HR = 11.33）（均P < 0.001）。
与无LM的患者相比，有LM的患者死亡HR更高，但脑肿瘤患者除外。临床医生应更加关注LM的发生，尤其是在死亡HR显著升高的患者中，如甲状腺癌、黑色素瘤和前列腺癌患者。
