肺癌骨转移临床诊疗专家共识2010【ppt】.ppt

* 骨转移对于肺癌的影响 The impact of bone metastasis in lung cancer1-4 Incidence 发病率 The skeleton is the most common site of bone metastases from solid tumors. The prevalence of bone involvement in advanced lung carcinoma is 30% to 40%,2 the higher incidence in the patients with small cell lung cancer (SCLC)4 骨骼是实体瘤发生转移的多发部位，恶性晚期肺癌的骨转移发生率为0～40％，在小细胞肺癌中的发病率更高 Prognosis 预后 Survival rates for patients with lung cancer complicated by bone metastases vary depending on the stage of the disease. Metastatic bone disease in lung cancer follows a relatively short clinical course: In patients with stage IV non-small cell lung cancer (NSCLC), the overall median survival is less than 6 months after diagnosis of bone metastases, with few patients surviving beyond 1 year3; according to a population-based program of the US National Cancer Institute, the 5-year survival in SCLC patients with extensive disease is 4.6%5 伴有骨转移的肺癌患者存活率根据其癌症分期不同而不同，肺癌中的转移性骨病一般发生在IV期非小细胞肺癌，骨转移诊断明确后总中位存活率低于6个月，很少患者能存活1年以上，美国国家癌症研究所进行的一项针对总体人群的研究证明，SCLC患者的5年存活率为4.6%. These survival rates are considerably shorter than those in other solid tumors with bone metastases, such as prostate cancer (median 40 months), breast cancer (median 25 months), and multiple myeloma (median 20 months)2 肺癌骨转移的存活率比其他实体瘤骨转移存活率低，例如前列腺癌（中位数为40个月），乳腺癌（中位数为25个月），多发性骨髓瘤（中位数为20个月） Classification 分类 Based on their radiographic appearance, metastatic bone lesions are usually referred to as osteolytic, osteoblastic (or osteosclerotic), or mixed. Bone lesions associated with lung cancer are predominantly osteolytic4 基于他们的放射影响学表现，转移性骨损伤通常表现为溶骨性、成骨性、和混合性损伤，肺癌以溶骨性骨损伤为主。 Etiology 病原学 Metastatic tumor cells release numerous soluble factors that stimulate osteoclasts to degrade bone and release other factors that stimulate further tumor-cell growth and stimulate osteoblasts to lay down new bone 转移性癌细胞释放大量溶解因子，刺激破骨细胞破坏骨并释放另一种因子，该因子刺激肿瘤细胞的生长并刺激成骨细胞产生新骨。 Mundy GR. Mechanisms of bone metastasis. Cancer. 1997;80:1546-1556. Coleman RE. Skeletal complic