Ⅳ期肺腺癌初诊时转移特征和生存分析*
Features of initially presenting metastases and survival analysis in patients with stage Ⅳ lung adenocarcinoma

目的:探讨初诊Ⅳ期肺腺癌患者转移的主要特征和临床预后。方法:回顾性收集160例经病理和全身成像证实的Ⅳ期肺腺癌患者的临床资料,应用Kaplan-Meier 方法计算生存率,采用Cox 多因素回归对预后因素进行分析。结果:肺腺癌最常见的转移部位为胸部淋巴结134例(83.8%)、肺/肺淋巴管101例(63.1%)和胸膜/心包71例(44.4%)。160例肺腺癌中位生存期为18.0个月,1、2、3 a生存率分别为64.6%、30.8%、20.1%。单因素生存分析结果显示,患者年龄、性别、肿瘤分化程度、胸部淋巴结有无转移、胸膜/心包有无转移、腹部/盆腔有无转移、颈部/腋窝淋巴结有无转移和有无用TKI治疗对生存率有影响(P＜0.05)。Cox回归分析结果显示,影响Ⅳ期肺腺癌患者生存率的危险因素有肿瘤分化程度(OR=2.648,95%CI=1.689～4.150)、颈部/腋窝淋巴结是否转移(OR=2.517,95%CI=1.358～4.664)、腹部/盆腔是否转移(OR=2.005,95%CI=1.203～3.342)、胸部淋巴结是否转移(OR=1.972,95%CI=1.067～3.645)、是否用TKI治疗(OR=1.694,95%CI=1.073～2.675)、胸膜/心包是否转移(OR=1.664,95%CI=1.050～2.637)。结论:Ⅳ期肺腺癌有独特的转移特征; 肿瘤分化程度,颈部/腋窝淋巴结、腹部/盆腔、胸部淋巴结、胸膜/心包是否转移,是否使用TKI治疗,可作为Ⅳ期肺腺癌患者预后的评价指标。
Aim: To investigate the features of metastasis and clinical prognosis of patients with stage Ⅳ lung adenocarcinoma.Methods: The clinical data of 160 stage Ⅳ lung adenocarcinoma patients who were confirmed by pathology and whole body imaging were retrospectively reviewed. The survival rate was evaluated by Kaplan-Meier method. The prognosis were analyzed by Cox multivariate regression.Results: The most common sites of metastasis of lung adenocarcinoma were thoracic lymph nodes(83.8%), pulmonary/pulmonary lymphatics(63.1%), and pleural/pericardial(44.4%). The median survival time was 18.0 months. One-, two- and three-year survival rates were 64.6%, 30.8%, and 20.1%, respectively.Univariate analysis showed that age, gender, tumor differentiation, thoracic lymph node metastasis status, pleural/pericardial metastasis, abdominal/pelvic metastasis, neck/axilla lymph node metastasis and TKI treatment had significant association with survival rate(P＜0.05). Cox regression analysis showed that tumor differentiation(OR=2.648, 95%CI=1.689-4.150), neck/axilla lymph node metastasis(OR=2.517, 95%CI=1.358-4.664), abdomen/pelvis metastasis(OR=2.005, 95%CI=1.203-3.342), thoracic lymph node metastasis status(OR=1.972, 95%CI=1.067-3.645), TKI treatment(OR=1.694, 95%CI=1.073-2.675), pleural/pericardial metastasis(OR=1.664, 95%CI=1.050-2.637)were risk factors of prognosis of lung adenocarcinoma.Conclusion: Stage Ⅳ lung adenocarcinoma has a unique characteristic of metastasis. Tumor differentiation, neck/axilla lymph node metastasis, abdomen/pelvis metastasis, thoracic lymph node metastasis status, TKI treatment, pleural/pericardial metastasis status of stage Ⅳ lung adenocarcinoma may be prognostic indicators