肺癌骨转移的预测因素、预防意义及个性化手术策略：基于人群的方法与基于综合癌症中心的研究
Predictive factors, preventive implications, and personalized surgical strategies for bone metastasis from lung cancer: population-based approach with a comprehensive cancer center-based study.
作者信息
Hu Xianglin, Huang Wending, Sun Zhengwang, Ye Hui, Man Kwong, Wang Qifeng, Sun Yangbai, Yan Wangjun
机构信息
Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China.
出版信息
EPMA J. 2022 Jan 10;13(1):57-75. doi: 10.1007/s13167-022-00270-9. eCollection 2022 Mar.
BACKGROUND
Bone metastasis (BM) and skeletal-related events (SREs) happen to advanced lung cancer (LC) patients without warning. LC-BM patients are often passive to BM diagnosis and surgical treatment. It is necessary to guide the diagnosis and treatment paradigm for LC-BM patients from reactive medicine toward predictive, preventive, and personalized medicine (PPPM) step by step.
METHODS
Two independent study cohorts including LC-BM patients were analyzed, including the Surveillance, Epidemiology, and End Results (SEER) cohort ( = 203942) and the prospective Fudan University Shanghai Cancer Center (FUSCC) cohort ( = 59). The epidemiological trends of BM in LC patients were depicted. Risk factors for BM were identified using a multivariable logistic regression model. An individualized nomogram was developed for BM risk stratification. Personalized surgical strategies and perioperative care were described for FUSCC cohort.
RESULTS
The BM incidence rate in LC patients grew (from 17.53% in 2010 to 19.05% in 2016). Liver metastasis was a significant risk factor for BM (OR = 4.53, 95% CI = 4.38-4.69) and poor prognosis (HR = 1.29, 95% CI = 1.25-1.32). The individualized nomogram exhibited good predictive performance for BM risk stratification (AUC = 0.784, 95%CI = 0.781-0.786). Younger patients, males, patients with high invasive LC, and patients with other distant site metastases should be prioritized for BM prevention. Spine is the most common site of BM, causing back pain (91.5%), pathological vertebral fracture (27.1%), and difficult walking (25.4%). Spinal surgery with personalized spinal reconstruction significantly relieved pain and improved daily activities. Perioperative inflammation, immune, and nutrition abnormities warrant personalized managements. Radiotherapy needs to be recommended for specific postoperative individuals.
CONCLUSIONS
The presence of liver metastasis is a strong predictor of LC-BM. It is recommended to take proactive measures to prevent BM and its SREs, particularly in young patients, males, high invasive LC, and LC with liver metastasis. BM surgery and perioperative management are personalized and required. In addition, adjuvant radiation following separation surgery must also be included in PPPM-guided management.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13167-022-00270-9.
背景
骨转移（BM）和骨相关事件（SREs）在晚期肺癌（LC）患者中毫无征兆地发生。LC-BM患者往往对BM诊断和手术治疗较为被动。有必要逐步引导LC-BM患者的诊断和治疗模式从反应性医学转向预测性、预防性和个性化医学（PPPM）。
方法
分析了两个独立的研究队列，包括LC-BM患者，即监测、流行病学和最终结果（SEER）队列（n = 203942）和前瞻性复旦大学附属上海肿瘤医院（FUSCC）队列（n = 59）。描述了LC患者中BM的流行病学趋势。使用多变量逻辑回归模型确定BM的危险因素。开发了一个个性化的列线图用于BM风险分层。针对FUSCC队列描述了个性化的手术策略和围手术期护理。
结果
LC患者的BM发病率有所上升（从2010年的17.53%升至2016年的19.05%）。肝转移是BM的一个显著危险因素（OR = 4.53，95%CI = 4.38 - 4.69）且预后较差（HR = 1.29，95%CI = 1.25 - 1.32）。个性化列线图在BM风险分层方面表现出良好的预测性能（AUC = 0.784，95%CI = 0.781 - 0.786）。年轻患者、男性、高侵袭性LC患者以及有其他远处转移的患者应优先进行BM预防。脊柱是BM最常见的部位，会导致背痛（91.5%）、病理性椎体骨折（27.1%）和行走困难（25.4%）。采用个性化脊柱重建的脊柱手术显著缓解了疼痛并改善了日常活动。围手术期的炎症、免疫和营养异常需要个性化管理。对于特定的术后个体需要推荐放疗。
结论
肝转移的存在是LC-BM的一个强有力的预测指标。建议采取积极措施预防BM及其SREs，特别是在年轻患者、男性、高侵袭性LC患者以及有肝转移的LC患者中。BM手术和围手术期管理是个性化且必要的。此外，在PPPM指导的管理中，分离手术后的辅助放疗也必须包含在内。
补充信息
在线版本包含可在10.1007/s13167 - 022 - 00270 - 9获取的补充材料。
Zotero 插件