肿瘤医院 内容 双膦酸盐的作用机制.pptVIP

※双膦酸盐使用时间：目前推荐至少6月，随着双膦酸盐用药时间的延长，能够有效减少SRE事件的发生，以及延缓SRE的发生时间 ※双膦酸盐使用时机： 应着重强调骨转移确诊后立即使用双膦酸盐，不要陷入出现SRE或者骨痛等症状才进行双膦酸盐治疗的误区※ 骨标记物的应用价值探讨：逐渐成熟，有待新的证据 小 结 谢 谢！ * 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 do