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背景与目的40%以上非小细胞肺癌(NSCLC)确诊即为Ⅳ期,可发生肺内或/和远处转移。不同转移部位对生存期的影响目前报道不多。本研究拟探讨NSCLC患者肺内转移与单一远处血行转移以及肺内转移并其它多部位转移的临床病理特点及生存期差异,从而探讨NSCLC肺内转移的预后相关因素。方法回顾性分析自1995年10月至2003年12月在我院经病理活检及全面分期检查确诊为Ⅳ期NSCLC、并有完整随访资料的425例患者,其中仅肺内转移而无其它部位转移者(单一肺内转移)81例,单一远处血行转移98例,肺内转移并其它部位转移68例。通过Kaplan-Meier曲线法计算生存率,Log-Rank检验比较三组生存期差异,单因素分析肺内转移的预后因素。结果81例肺内转移者中位生存期(MST)及1、2、3年生存率(SR)分别为13个月(95%CI11~15),57%、21%、7%;N1/N2者MST22个月,N3者10个月(P=0.0011);同侧、对侧及双侧肺内转移者MST及年SR差异无统计学意义(P>0.05);单一肺内转移MST及年SR与单一脑或骨转移无显著性差异(P>0.05),但单一肺内转移生存期长于肺并其它部位转移(MST9个月,1、2、3年SR分别为40%、9.4%、1.5%)(P=0.021)。单因素分析年龄、病理亚型、分化程度、化疗疗效对单一肺内转移的NSCLC生存期无影响(P>0.05),性别及淋巴结转移(N1/N2比N3)与生存相关(P=0.018,P=0.001);将年龄分层进行分析,淋巴结转移(N1/N2比N3)为此组患者的独立预后因素(P=0.002)。在肺并其它部位转移者,转移数目(2vs≥3)系独立预后因素(P=0.013)。结论NSCLC单一肺内转移者生存期与单一脑、骨等远处转移者无显著差异,但长于肺并其它部位转移者。淋巴结转移状况(N1+2比N3)及远处转移数目(2比≥3)分别影响单一肺内转移及肺并其它部位转移者的预后。
Background and objective More than 40% of non-small cell lung cancer (NSCLC) is diagnosed as stage IV, and may occur intrapulmonary and / or distant metastasis. The impact of different metastatic sites on the survival is currently little reported. This study was to investigate the clinicopathological features and survival of NSCLC patients with intrapulmonary metastases and single distant hematogenous metastases, and intrapulmonary metastasis and other multi-site metastases, so as to explore the prognostic factors associated with lung metastasis of NSCLC. Methods A retrospective analysis was performed on 425 patients with stage Ⅳ NSCLC diagnosed by pathological biopsy and total staging in our hospital from October 1995 to December 2003 with complete follow-up data. Only lung metastasis was found in the study without metastasis to other sites (A single lung metastasis) in 81 cases, a single remote hematogenous metastasis in 98 cases, lung metastasis and other parts of the transfer in 68 cases. The survival rate was calculated by Kaplan-Meier curve method. The Log-Rank test was used to compare the survival differences among the three groups and the prognostic factors of lung metastasis by univariate analysis. Results The median survival time (MST) and 1, 2, 3 year survival rate (SR) of 81 patients with pulmonary metastasis were 13 months (95% CI 11-15), 57%, 21% and 7% N2 were MST for 22 months and N3 for 10 months (P = 0.0011). There was no significant difference in MST and SR between ipsilateral, contralateral and bilateral lung metastases (P> 0.05) The annual SR had no significant difference with single brain or bone metastasis (P> 0.05), but the single lung metastasis survival longer than the lung and other parts metastasis (MST 9 months, 1, 2, 3 years SR were 40%, 9.4% , 1.5%) (P = 0.021). Univariate analysis showed that age, pathological subtypes, differentiation and chemotherapy had no effect on the survival of NSCLC with single lung metastasis (P> 0.05), and gender and lymph node metastasis (N1 / N2 vs N3) P = 0.001) .According to age stratification, lymph node metastasis (N1 / N2 vs N3) was an independent prognostic factor in this group (P = 0.002). In lung and other metastases, the number of metastases (2 vs ≥ 3) was an independent prognostic factor (P = 0.013). Conclusion There is no significant difference in survival between single lung metastasis and single brain metastasis in NSCLC patients, but it is longer than those in lung and other metastases. The status of lymph node metastasis (N1 + 2 vs N3) and the number of distant metastases (2 vs ≥3) affect the prognosis of single lung metastasis and other lung metastases, respectively.