Seto T, Imamura F, Kuriyama K, Funakoshi T, Gotoh H, Nakayama T, Nakamura S, Horai T
Department of Pulmonary Oncology, Osaka Medical Centre for Cancer and Cardiovascular Diseases, Japan.
Eur J Cancer. 1997 Dec;33(14):2333-7. doi: 10.1016/s0959-8049(97)00348-1.
The staging system of limited disease (LD) and extensive disease (ED) is widely used and has been shown to provide useful prognostic information in cases of small cell lung cancer (SCLC). However, accurate examinations are necessary for correct staging. In this report, we evaluated the clinical usefulness of magnetic resonance imaging (MRI) of bone marrow in SCLC. 37 patients with LD by standard staging and 41 with ED were examined with bone marrow MRI. Results of bone marrow MRI did not influence the choice of treatment in patients with LD. For subsequent analysis, patients with LD were divided into two groups: patients in whom bone marrow infiltration was detected with MRI (MRI-positive LD group) and those in whom it was not (MRI-negative LD group). Focal or diffuse metastases to bone marrow were detected with MRI in 46% (36/78) of all patients and 35% (13/37) of LD patients. The response rates to treatment in patients with MRI-positive LD were lower than those in patients with MRI-negative LD (P = 0.006). The survival of patients with MRI-positive LD was worse than that of MRI-negative LD (generalised Wilcoxon test: P = 0.0157), and closer to that of ED. Multivariate analyses using a Cox model that included the result of bone marrow MRI, performance status, chemotherapy regimen, radiotherapy and serum lactose dehydrogenase (LDH) level showed that the result of bone marrow MRI remained a prognostic factor in SCLC patients with limited disease. Bone marrow examination with MRI is useful for better staging of SCLC. According to our analysis of response rates and survival, MRI-positive LD should be considered a type of ED.
局限期（LD）和广泛期（ED）的分期系统被广泛应用，且已证明在小细胞肺癌（SCLC）病例中能提供有用的预后信息。然而，准确的检查对于正确分期是必要的。在本报告中，我们评估了骨髓磁共振成像（MRI）在SCLC中的临床应用价值。对37例经标准分期为LD的患者和41例ED患者进行了骨髓MRI检查。骨髓MRI结果并未影响LD患者的治疗选择。为进行后续分析，将LD患者分为两组：MRI检测到骨髓浸润的患者（MRI阳性LD组）和未检测到骨髓浸润的患者（MRI阴性LD组）。在所有患者中，46%（36/78）以及LD患者中35%（13/37）通过MRI检测到骨髓有局灶性或弥漫性转移。MRI阳性LD患者的治疗缓解率低于MRI阴性LD患者（P = 0.006）。MRI阳性LD患者的生存率低于MRI阴性LD患者（广义Wilcoxon检验：P = 0.0157），且更接近ED患者。使用Cox模型进行多因素分析，纳入骨髓MRI结果、体能状态、化疗方案、放疗及血清乳酸脱氢酶（LDH）水平，结果显示骨髓MRI结果仍是局限期SCLC患者的一个预后因素。骨髓MRI检查有助于更好地对SCLC进行分期。根据我们对缓解率和生存率的分析，MRI阳性LD应被视为一种ED类型。
