CAJ | 학술논문

目的：探讨非小细胞肺癌（NSCLC ）骨转移患者发生骨相关事件（SREs）的临床预测因子并分析其预后因素。方法收集2007年4月至2014年1月该院经病理证实的383例NSCLC患者临床资料。骨转移采用同位素全身骨扫描（ECT ）筛选，通过CT、MRI、PET‐CT或病理活检证实。统计患者临床特征，应用单因素、多因素分析SREs发生的预测因素，并用Kaplan‐Meier法进行NSCLC骨转移患者的生存分析。结果383例NSCLC骨转移患者，发生SREs 178例，SREs发生率46．5％。单因素分析显示女性、腺癌、不吸烟、单发骨转移、双膦酸盐（BPs）治疗、曾采用EGFR酪氨酸激酶抑制剂（EGFR‐TKIs）治疗患者SREs发生率更低，差异有统计学意义（ P＜0．05）；多因素分析表明多发骨转移与无双膦酸盐治疗史是发生 SREs的独立风险因素。NSCLC骨转移患者的中位生存时间为14．5个月，1年生存率为46．5％、2年生存率为15．9％，生存分析显示双膦酸盐治疗周期数和双膦酸盐联合EGFR‐TKIs治疗对患者预后有影响（P＜0．05）。结论 NSCLC骨转移患者易发SREs ，多发骨转移和无双膦酸盐治疗史是发生SREs的独立风险因素，双膦酸盐治疗NSCLC骨转移患者可能预防或减少SREs发生，并可能延长生存，推测双膦酸盐可能具有抗NSCLC细胞活性。
목적：탐토비소세포폐암（NSCLC ）골전이환자발생골상관사건（SREs）적림상예측인자병분석기예후인소。방법수집2007년4월지2014년1월해원경병리증실적383례NSCLC환자림상자료。골전이채용동위소전신골소묘（ECT ）사선，통과CT、MRI、PET‐CT혹병리활검증실。통계환자림상특정，응용단인소、다인소분석SREs발생적예측인소，병용Kaplan‐Meier법진행NSCLC골전이환자적생존분석。결과383례NSCLC골전이환자，발생SREs 178례，SREs발생솔46．5％。단인소분석현시녀성、선암、불흡연、단발골전이、쌍련산염（BPs）치료、증채용EGFR락안산격매억제제（EGFR‐TKIs）치료환자SREs발생솔경저，차이유통계학의의（ P＜0．05）；다인소분석표명다발골전이여무쌍련산염치료사시발생 SREs적독립풍험인소。NSCLC골전이환자적중위생존시간위14．5개월，1년생존솔위46．5％、2년생존솔위15．9％，생존분석현시쌍련산염치료주기수화쌍련산염연합EGFR‐TKIs치료대환자예후유영향（P＜0．05）。결론 NSCLC골전이환자역발SREs ，다발골전이화무쌍련산염치료사시발생SREs적독립풍험인소，쌍련산염치료NSCLC골전이환자가능예방혹감소SREs발생，병가능연장생존，추측쌍련산염가능구유항NSCLC세포활성。
Objective To explore skeletal‐related events (SREs) clinical factors and analysis prognosis factors on patients with non‐small cell lung cancer(NSCLC) with bone metastases .Methods We collected clinical data of pathology confirmed 383 patients with non‐small cell lung cancer between April 2007 and January 2007 in the third affiliated hospital of the third military medical uni‐versity .It was used to screening for Emission Computed Tomography (ECT ) for bone metastases .And then it was need to con‐firmed for CT ,MRI or PET‐CT or pathology .Statistics in patients between clinical features and the SREs prediction factor with Univariate and Multivariate .And Kaplan‐Meier method analysis of survival in the non‐small cell lung cancer patients with bone me‐tastases .Results Out of 383 patients with bone metastases ,178 patients with SREs .The incidence was 46 .5% .Univariate analysis showed that women ,adenocarcinoma ,never smoking history ,single bone metastases ,bisphosphonate therapy ,targeted therapy in patients with bone metastases are less likely to have SREs ,it was considered statistically significant (P<0 .05) .Multivariate analy‐sis showed multiple bone metastases and no bisphosphonate therapy is independent risk factors for SREs .Median survival time was 14 .5 months in non‐small cell lung cancer patients with bone metastases ,1 year survival rate was 46 .5% ,2 years survival rate was 15 .9% .The survival analysis shows that more bisphosphonate treatment and bisphosphonate with EGFR‐TKI therapy on the prog‐nosis of patients with statistically significance (P<0 .05) .Conclusion It was likely to occur SREs in NSCLC patients with bone metastases .No bisphosphonate and multiple bone metastases are independent risk factors for SREs .Bisphosphonate treatment may prevent or reduce occur SREs for NSCLC patients with bone metastases ,and it may prolong survival ,it speculated that bisphospho‐nate may have resistant NSCLC cell activity .