Clinical associations and prognostic value of site-specific metastases in non-small cell lung cancer: A population-based study
Clinical associations and prognostic value of site-specific metastases in non-small cell lung cancer: A population-based study
复制标题
非小细胞肺癌特定部位转移的临床关联和预后价值：一项基于人群的研究
DOI：
10.3892/ol.2019.10225
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Sun, Jianguo
中科院分区：
文献类型：
--
作者：
Xu, Zihan;Yang, Qiao;Sun, Jianguo
非小细胞肺癌（NSCLC）的预后较差，特别是有转移性疾病的患者。为了改善这些患者的预后，已经做出了许多努力；然而，只有少数研究系统地探讨了不同类型的远处转移（DM）在非小细胞肺癌中的发生率及预后价值。为了调查这些问题，从监测、流行病学和最终结果数据库中收集了2010年至2014年间诊断为NSCLC的患者的信息。生存率比较采用Kaplan-Meier分析和log-rank检验。建立Cox比例风险模型以确定与总生存期（OS）和癌症特异性生存期（CSS）改善相关的因素。本研究显示，NSCLC的单次转移发生部位以骨为最常见，以肝脏为最不常见。在多部位转移中，最常见的是骨、肺两部位转移，最常见的是骨、肝、肺三部位转移。至于NSCLC亚型，大细胞癌（LCC）表现出更特异性的转移特征。LCC患者最常见的单转移部位是大脑，最常见的双转移部位是骨和肝脏。孤立性肝转移患者的OS和CSS在单一转移患者中表现最差。此外，对于多部位转移的患者，在各种组合中，肝脏转移与最差的OS和CSS相关。据我们所知，本研究首次使用基于人群的大型数据集调查非小细胞肺癌不同部位特异性DM转移模式的发生率和预后价值。本研究结果可能对晚期NSCLC患者的分类具有重要意义，从而为个体化精准治疗奠定基础。
The prognosis of non-small cell lung cancer (NSCLC) is poor, particularly for patients with metastatic disease. Numerous efforts have been made to improve the prognosis of these patients; however, only a small number of studies have explored the occurrence rate and prognostic value of different patterns of distant metastasis (DM) in NSCLC systematically. To investigate these, information from patients diagnosed with NSCLC between 2010 and 2014 was collected from the Surveillance, Epidemiology and End Results database. Survival rate comparisons were performed using Kaplan-Meier analysis and log-rank tests. A Cox proportional hazard model was established to determine factors associated with improved overall survival (OS) and cancer-specific survival (CSS). The present study revealed that the most common site of single metastasis occurrence was bone, and the least common was the liver for NSCLC. As for multi-site metastases, the most common two-site metastasis involved bone and lung, and the most common three-site metastasis involved bone, liver and lung. As for NSCLC subtypes, large cell carcinoma (LCC) exhibited more specific metastatic features. The most common single metastatic site was the brain for patients with LCC, and the most common two-site metastatic combination was bone and liver. Patients with isolated liver metastasis exhibited the worst OS and CSS among patients with single metastasis. Furthermore, for patients with multi-site metastases, metastases involving the liver were associated with the worst OS and CSS among various combinations. To the best of our knowledge, the present study is the first to investigate the occurrence rate and prognostic value of different metastatic patterns of site-specific DM for NSCLC using a large population-based dataset. The findings of the present study may have vital implications for classifying patients with advanced NSCLC, thus laying a foundation for individualized precise treatment.