男性乳腺癌治疗进展.ppt

**骨转移对于肺癌的影响Theimpactofbonemetastasisinlungcancer1-4Incidence发病率Theskeletonisthemostcommonsiteofbonemetastasesfromsolidtumors.Theprevalenceofboneinvolvementinadvancedlungcarcinomais30%to40%,2thehigherincidenceinthepatientswithsmallcelllungcancer(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Survivalratesforpatientswithlungcancercomplicatedbybonemetastasesvarydependingonthestageofthedisease.Metastaticbonediseaseinlungcancerfollowsarelativelyshortclinicalcourse:InpatientswithstageIVnon-smallcelllungcancer(NSCLC),theoverallmediansurvivalislessthan6monthsafterdiagnosisofbonemetastases,withfewpatientssurvivingbeyond1year3;accordingtoapopulation-basedprogramoftheUSNationalCancerInstitute,the5-yearsurvivalinSCLCpatientswithextensivediseaseis4.6%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%.Thesesurvivalratesareconsiderablyshorterthanthoseinothersolidtumorswithbonemetastases,suchasprostatecancer(median40months),breastcancer(median25months),andmultiplemyeloma(median20months)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Basedontheirradiographicappearance,metastaticbonelesionsareusuallyreferredtoasosteolytic,osteoblastic(orosteosclerotic),ormixed.Bonelesionsassociatedwithlungcancerarepredominantlyosteolytic4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Metastatictumorcellsreleasenumeroussolublefactorsthatstimulateosteoclaststodegradeboneandreleaseotherfactorsthatstimulatefurthertumor-cellgrowthandstimulateosteoblaststolaydownnewbone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。MundyGR.Mechanismsofbonemetastasis.Cancer.1997;80:1546-1556.ColemanRE.Skeletalcompl