Background

A significant number of non-small cell lung cancer (NSCLC) patients develop osteogenic metastases (OMs) and/or brain metastases (BMs) after surgery, however, routine chest computed tomography (CT) sometimes fails to diagnose these recurrences. We investigated the incidence of BMs and OMs after pulmonary resection and aimed to identify candidates who can benefit from brain magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in addition to CT.

Methods

We retrospectively reviewed medical records of 1099 NSCLC patients who underwent pulmonary resection between 2002 and 2013. Clinicopathological factors associated with OM and/or BM were investigated using univariate and multivariate analyses.

Results

Postoperative recurrence occurred in 344 patients (32.6%). OMs were diagnosed in 56 patients (5.6%) with 93% within 3 years. BMs were identified in 72 patients (6.6%) with 91.1% within 3 years. Multivariate analysis revealed that poorly differentiated tumor and the presence of pathological nodal metastases were significantly associated with postoperative BM (p = 0.037, < 0.001), preoperative serum carcinoembryonic antigen (CEA) level of 5 ng/mL or higher and the presence of pathological nodal metastases were significantly associated with OM (p = 0.034, < 0.001). The prevalence of OM and/or BM in 5 years was as high as 25.9% in patients with pathological nodal metastases.

Conclusions

We identified significant predictive factors of postoperative BM and OM. Under patient selection, the effectiveness of intensive surveillance for the modes of recurrence should be investigated with respect to earlier detection, maintenance of quality of life, and survival outcomes.

中文翻译：

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非小细胞肺癌切除术后的成骨和脑转移

背景

大量非小细胞肺癌 (NSCLC) 患者在手术后发生成骨转移 (OM) 和/或脑转移 (BM)，然而，常规胸部计算机断层扫描 (CT) 有时无法诊断这些复发。我们调查了肺切除术后 BMs 和 OMs 的发生率，旨在确定除了 CT 之外还可以从脑磁共振成像 (MRI) 和¹⁸ F-氟脱氧葡萄糖-正电子发射断层扫描 (FDG-PET) 中受益的候选人。

方法

我们回顾性审查了 2002 年至 2013 年间接受肺切除术的 1099 名 NSCLC 患者的医疗记录。使用单变量和多变量分析研究了与 OM 和/或 BM 相关的临床病理因素。

结果

术后复发 344 例（32.6%）。56 名患者 (5.6%) 被诊断为 OM，其中 93% 在 3 年内被诊断出。在 72 名患者 (6.6%) 中发现了 BM，其中 91.1% 在 3 年内。多变量分析显示，低分化肿瘤和病理淋巴结转移与术后 BM ( p  = 0.037, < 0.001)、术前血清癌胚抗原 (CEA) 水平≥5 ng/mL 和病理淋巴结转移显着相关。转移与 OM 显着相关 ( p  = 0.034, < 0.001)。病理性淋巴结转移患者 5 年内 OM 和/或 BM 的患病率高达 25.9%。

结论

我们确定了术后 BM 和 OM 的重要预测因素。在选择患者时，应在早期发现、维持生活质量和生存结果方面研究针对复发模式的强化监测的有效性。