Lim Jeong Uk, Kim Kyu Yean, Kim Ho Cheol, Kim Tae-Jung, Kim Hong Kwan, Moon Mi Hyoung, Beck Kyongmin Sarah, Suh Yang Gun, Song Chang Hoon, Ahn Jin Seok, Lee Jeong Eun, Jeon Jae Hyun, Jung Chi Young, Cho Jeong Su, Choi Yoo Duk, Hwang Seung Sik, Park Young Sik, Yoon Soon Ho, Choi Joon Young, Choi Chang-Min, Jang Seung Hun
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
Transl Lung Cancer Res. 2025 Feb 28;14(2):363-384. doi: 10.21037/tlcr-24-770. Epub 2025 Jan 21.
Personalized management of stage IV lung cancer requires a deeper understanding of metastatic patterns and the potential benefits of localized treatments for each histologic type. This study aims to identify patterns of both intrathoracic and extrathoracic metastases across various histologic types of lung cancer using a nationwide Korean lung cancer database.
The study analyzed data from patients diagnosed with lung cancer between 2014 and 2019, sourced from the Korean Association of Lung Cancer Registry (KALC-R). Patients with stage IV lung cancer, indicated by M staging, were included to focus on metastatic patterns.
The cohort included 7,562 stage IV lung cancer patients, with adenocarcinoma being the most prevalent histologic type, comprising 49.22% of cases (3,722 patients). M stage categorization showed that 27.3% were M1a, 56.3% M1b, 15.7% M1c, and 0.6% unspecified. The adenosquamous type had the highest proportion of patients with metastases in three or more organs (42.9%). Metastases to the liver and bones were consistently associated with decreased survival across histologic types. In adenocarcinoma, strong associations were observed between extrathoracic metastatic sites, particularly between bone and liver [odds ratio (OR) =3.93] and liver and adrenal glands (OR =2.85). Multivariate analysis revealed that patients receiving radiotherapy to lung lesions had significantly better overall survival (OS) [hazard ratio (HR) =0.68; 95% confidence interval (CI): 0.60-0.78; P<0.001] compared to those who did not. Radiotherapy to extrathoracic metastases also significantly improved survival (HR =0.84; 95% CI: 0.77-0.93; P<0.001).
Understanding metastasis patterns and treatment options specific to each lung cancer histologic type is essential for improving treatment strategies.
IV期肺癌的个性化管理需要更深入地了解转移模式以及针对每种组织学类型的局部治疗的潜在益处。本研究旨在利用韩国全国肺癌数据库确定各种组织学类型肺癌的胸内和胸外转移模式。
该研究分析了2014年至2019年间诊断为肺癌的患者的数据，数据来源于韩国肺癌协会登记处（KALC-R）。纳入M分期表明为IV期肺癌的患者，以关注转移模式。
该队列包括7562例IV期肺癌患者，腺癌是最常见的组织学类型，占病例的49.22%（3722例患者）。M分期分类显示，27.3%为M1a，56.3%为M1b，15.7%为M1c，0.6%未明确。腺鳞癌类型在三个或更多器官发生转移的患者比例最高（42.9%）。肝转移和骨转移在所有组织学类型中均与生存率降低持续相关。在腺癌中，观察到胸外转移部位之间存在强关联，特别是骨与肝之间[优势比（OR）=3.93]以及肝与肾上腺之间（OR =2.85）。多变量分析显示，与未接受肺部病变放疗的患者相比，接受肺部病变放疗的患者总生存期（OS）显著更好[风险比（HR）=0.68；95%置信区间（CI）：0.60-0.78；P<0.001]。胸外转移灶放疗也显著提高了生存率（HR =0.84；95%CI：0.77-0.93；P<0.001）。
了解每种肺癌组织学类型特有的转移模式和治疗选择对于改善治疗策略至关重要。
