不同病理分型的初治非小细胞肺癌骨转移患者的预后分析  

Prognostic analysis of patients with bone metastases from primary non-small cell lung cancer with different pathologic staging

作　　者：胡雪艳 孟凡亮[1] 董娟娟[2] HU Xueyan;MENG Fanliang;DONG Juanjuan(Department of Respiratory Medicine,Chaohu Hospital of Anhui Medical University,Chaohu 238000,China;不详)

机构地区：[1]安徽医科大学附属巢湖医院呼吸内科,安徽巢湖238000 [2]安徽医科大学附属巢湖医院肿瘤内科,安徽巢湖238000

出　　处：《实用医学杂志》2024年第16期2316-2325,共10页The Journal of Practical Medicine

基　　金：安徽省高等学校科学研究项目(编号:2023AH050687);安徽医科大学校科研基金项目(编号:2020xkj050)。

摘　　要：目的了解不同病理类型的初治非小细胞肺癌(Non-small cell lung cancer,NSCLC)骨转移患者经过不同一线治疗方案的预后,以便对临床预测疾病进展、指导治疗、改善预后提供帮助。方法选择安徽医科大学附属巢湖医院2019年1月1日至2023年12月31日收入初治伴有骨转移的403名NSCLC患者,运用生存分析(Log-rank检验)进行单因素分析,Cox回归多因素分析,发现组织病理分型是影响患者预后的独立因素(P=0.001,HR=1.952),之后去除该因素对预后的影响,将全部人数按照病理组织分型分为腺癌组(316例)、鳞癌组(87例)两组后再次使用Cox回归模型进行多因素分析,分析影响生存预后的因素。结果在此次数据分析中,病理类型为鳞癌的患者的中位生存期(median overall survival,mOS)为15月(95%CI:12.85~17.15),中位无进展生存期(median progression-free survival,mPFS)为9月(95%CI:7.34~10.67),而腺癌组患者的mOS为25月(95%CI:23.26~26.74),mPFS为16月(95%CI:14.43~17.57),差异有统计学意义。整体组的OS受到多方面因素的影响,包括初诊时美国东部肿瘤协作组织(Eastern Cooperative Oncology Group,ECOG)评分状态(1分/>1分)、骨转移至躯干+四肢骨+颅骨、骨转移灶数量≥4个、ALK靶点基因突变、以及一线治疗使用化疗+靶向治疗等因素影响;同样地,PFS也受到上述因素的影响。另外在以病理组织分型为依据的腺癌组模型以及鳞癌组模型中得出化疗+靶向治疗,化疗+免疫治疗分别为两组的保护因素,ALK靶点基因突变仅为腺癌组的保护因素。结论本研究进一步确认了初治NSCLC骨转移患者的预后影响因素,为临床治疗提供了重要参考。Objective To understand the prognosis of patients with bone metastases from first-treatment non-small cell lung cancer(NSCLC)of different pathological types after different first-line treatment regimens,in order to provide clinical prediction of disease progression,guidance of treatment,and improvement of prognosis.Methods 403 NSCLC patients with bone metastases who received primary treatment with bone metastases from Chaohu Hospital of Anhui Medical University from 1 January 2019 to 31 December 2023 were selected for univariate analysis using survival analysis(Log-rank test)and multifactorial analysis with Cox regression,and it was found that histopathological subtyping was an independent factor affecting the prognosis of patients(P=0.001,HR=1.952),after which the effect of this factor on prognosis was removed,and the total number of patients was divided into two groups according to histopathological classification:adenocarcinoma group(316)and squamous carcinoma group(87),and then multifactorial analysis was performed again using Cox regression model to analyse the factors affecting survival prognosis.Results In this data analysis,patients with the pathological type of squamous carcinoma had a median overall survival(mOS)of 15 months(95%CI:12.85~17.15)and a median progression-free survival(mPFS)of 9 months(95%CI:7.34~10.67),whereas patients in the adenocarcinoma group had a mOS of 25 months(95%CI:23.26~26.74)and mPFS was 16 months(95%CI:14.43~17.57),a statistically significant difference.The OS of the overall group was affected by multiple factors,including Eastern Cooperative Oncology Group(ECOG)score status(1/>1)at the time of initial diagnosis,bone metastases to Trunk+limb bones+cranium,number of bone metastases≥4,mutation of ALK target genes,and the use of chemotherapy+targeted therapy as the first line of treatment.therapy;similarly,PFS was also affected by the above factors.In addition,in the adenocarcinoma and squamous carcinoma models based on histopathological classification,chemotherapy+targeted ther

关 键 词：非小细胞肺癌 骨转移 组织病理 预后 影响因素 

分 类 号：R734.2[医药卫生—肿瘤]