進行肺がんの転移臓器と予後との関連

論文No2153

Association of specific metastatic organs with the prognosis and chemotherapeutic response in patients with advanced lung cancer
Nobuhiro Kanaji, Akira Tadokoro, Naoki Watanabe, Takuya Inoue, ... Tomoya Ishii
Respiratory Investigation, Volume 57, Issue 5, September 2019, Pages 472-480

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＜背景＞

この研究は、進行肺がんにおいて特異的な臓器転移が予後、治療効果に与える影響について検討した。

＜方法＞

後ろ向きに、病理的に診断された進行肺がん患者400名を解析し、

患者の転移の状態と予後、一次治療への反応との関連を検討した。

胸腔内（肺内転移、胸水、心嚢水）への転移は１つの臓器とカウントした。

＜結果＞

患者の転移臓器の数は以下のようであった：１つ（n=199)、２つ（n-99)、３つ（n=61)、４つ以上（n=41）。

多変量解析で、肝臓転移、筋肉転移は全生存期間が短かった (median of 207 and 120 days, respectively)、

また無増悪生存期間も短かった (median of 125 and 53 days, respectively)。

胸腔内、骨、脳、リンパ節転移は生存と関連しなかった。

筋肉あるいは皮膚転移があると、ない場合よりも１次治療への反応性が悪かった

(14.3% vs. 49.4% and 11.1% vs. 48.9% in patients with vs. without muscle or skin metastasis, respectively)。

＜感想＞

筋肉、肝臓への転移があると進行肺がんの予後が悪かったようです。
また筋肉、皮膚への転移があると一次治療への反応性が悪かったようです。

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Background
This study was performed to investigate the influence of specific metastatic organs on the prognosis and therapeutic effect in patients with advanced lung cancer.

Methods
We retrospectively analyzed 400 patients with pathologically diagnosed advanced lung cancer to determine the association of the patients’ metastatic status with their prognoses and responses to first-line therapy. Metastases within the chest cavity (pulmonary metastasis, pleural effusion, and pericardial effusion) were counted as one organ.

Results
The numbers of metastatic organs in the patients were as follows: one (n=199 patients), two (n=99), three (n=61), and four or more (n=41). A multivariate analysis showed that liver and muscle metastases were independently associated with shorter overall survival (median of 207 and 120 days, respectively) and shorter progression-free survival (median of 125 and 53 days, respectively). Chest cavity, bone, brain, and lymph node metastases were not associated with survival. The presence of either muscle or skin metastasis was associated with a lower response rate to first-line therapy than was the absence of each metastasis (14.3% vs. 49.4% and 11.1% vs. 48.9% in patients with vs. without muscle or skin metastasis, respectively).

Conclusions
Muscle and liver metastases were associated with poor outcomes. Muscle and skin metastases were associated with a lower response rate to treatment. For patients with advanced lung cancer, oncologists should select treatment strategies considering the patients’ metastatic statuses as well as other clinical characteristics.