CAJ | 학술논문

目的分析初诊临床Ⅳ期非小细胞肺癌的远处转移特点,为局部三维放疗可能性提供参考.方法回顾分析546例临床Ⅳ期非小细胞肺癌初诊时远处转移器官、病灶部位、数目等特点,以及肿瘤分期对远处转移率的影响.结果 546例患者中骨、脑、肺、肝、肾上腺、远处淋巴结、皮下、其他器官转移分别为294、167、137、79、66、37、35、10例.单器官转移379例,其中骨、脑、肺、肝、肾上腺、远处淋巴结、皮下、其他器官转移分别占37.7％、19.8％、16.9％、7.4％、7.4％、4.5％、5.5％、0.8％.T3+4期骨转移率与T1+2期的差异无统计学意义(69.4％、30.6％,x2=7.65,P=0.067),而N2+3的显著高于N0+1(69.7％、30.3％,x2=7.89,P=0.044).T3+4期脑转移率显著高于T1+2期的(70.7％、29.3％,x2=10.64,P=0.018),而N2+3期与N0+1期的差异无统计学意义(54.5％、45.5％,x2=7.14,P=0.079),但N1+2+3期的显著高于No期的(86.8％、13.2％,x2=10.26,P=0.024).结论 Ⅳ期非小细胞肺癌初诊时远处转移率由高到低依次为骨、脑、肺、肝、肾上腺和其他器官并以单器官多见；局部病灶分期越晚远处转移率越高；提示三维放疗技术可用于改善部分Ⅳ期NSCLC患者生活质量并延长生存时间.
목적 분석초진림상Ⅳ기비소세포폐암적원처전이특점,위국부삼유방료가능성제공삼고.방법 회고분석546례림상Ⅳ기비소세포폐암초진시원처전이기관、병조부위、수목등특점,이급종류분기대원처전이솔적영향.결과 546례환자중골、뇌、폐、간、신상선、원처림파결、피하、기타기관전이분별위294、167、137、79、66、37、35、10례.단기관전이379례,기중골、뇌、폐、간、신상선、원처림파결、피하、기타기관전이분별점37.7％、19.8％、16.9％、7.4％、7.4％、4.5％、5.5％、0.8％.T3+4기골전이솔여T1+2기적차이무통계학의의(69.4％、30.6％,x2=7.65,P=0.067),이N2+3적현저고우N0+1(69.7％、30.3％,x2=7.89,P=0.044).T3+4기뇌전이솔현저고우T1+2기적(70.7％、29.3％,x2=10.64,P=0.018),이N2+3기여N0+1기적차이무통계학의의(54.5％、45.5％,x2=7.14,P=0.079),단N1+2+3기적현저고우No기적(86.8％、13.2％,x2=10.26,P=0.024).결론 Ⅳ기비소세포폐암초진시원처전이솔유고도저의차위골、뇌、폐、간、신상선화기타기관병이단기관다견；국부병조분기월만원처전이솔월고；제시삼유방료기술가용우개선부분Ⅳ기NSCLC환자생활질량병연장생존시간.
Objective To investigate the clinical metastasis features and the possibility of 3 dimensional radiotherapy of stage Ⅳ non-small cell lung cancer (NSCLC). Methods The clinical materials of 546 patients with stage Ⅳ NSCLC and the relationship b T and N stage and metastasis were retrospectively analyzed. Results In 546 patients with stage Ⅳ NSCLC, the number with bone metastasis was 294, the number with brain metastasis was 167 , the number with lung metastasis was 137 , the number with liver metastasis was 79, the number with adrenal gland metastasis was 66, 37 with lymph node metastasis, 35 with subcutaneous metastasis and 10 with other organ metastasis. The number with single organ metastasis was 379 ( 69. 4％ ) ,in which 37. 7％ with bone metastasis, 19. 8％ with brain metastasis,16. 9％ with lung metastasis ,7. 4％ with liver metastasis, 7. 4％ with adrenal gland metastasis , 4. 5％ with lymph node metastasis ,5. 5％ with subcutaneous metastasis and 0. 8％ with other organ metastasis. The bone metastasis probability of T3 +4 patient was similar with T1+2 ( 69. 4％ , 30. 6％ , X2 = 7. 65 , P = 0. 067 ) , but N2+3 patient was more than No+1 ( 69. 7％ , 30. 3％ , X2 = 7. 89 , P = 0. 044) . The brain metastasis probability of T3 +4 patient was more than T1 +2 ( 70. 7％ , 29. 3％ , X2 = 10. 64 ,P = 0. 018) , but N2+3 patient was similar with N0+1 ( 54. 5％ ,45. 5％ , X2 = 7. 14 ,P = 0. 079) , and N1+3 +3 patient was more than N0 ( 86. 8％ , 13. 2％ ,X2 = 10. 26 ,P = 0. 024) . Conclusions In 546 patients with stage Ⅳ NSCLC , the most common metastatic organ is bone, the second is brain, the third is lung, the forth is liver, followed by adrenal gland; single organ metastasis is more common than multiple organ metastasis. The later the T stage is, the more severe is the metastasis. Through 3 dimensional radiotherapy, not only the quality of life of some stage Ⅳ patients is improved, but also the survival time was prolonged observably.