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目的 通过对晚期非小细胞肺癌(NSCLC)肝转移患者临床病理特征的分析，探讨影响NSCLC发生肝转移及其预后的危险因素。方法 纳入2010年1月1日至2019年12月30日2 261例初诊即发现远处转移的NSCLC患者的临床回顾性资料，研究资料均采集于美国国家癌症研究所监测、流行病学及终点事件数据库(SEER)。采取χ2检验和二元逻辑回归模型，对依照有无肝转移划分为肝转移组(n=530例)和非肝转移组(n=1731例)的两组患者进行临床病理特点的分析，得到影响NSCLC肝转移发生的独立危险因素。选取Kaplan-Meier法获得肝转移组的总生存时间(OS)，采取Log-rank法和多因素Cox回归模型分析肝转移组预后生存情况，探讨NSCLC肝转移患者预后的独立影响因素。应用R软件制作列线图(Nomogram)并计算一致性指数(C-index)。结果检验结果显示，NSCLC肝转移组与非肝转移组相比，临床病理特征包括诊断年龄(χ2=9.12,P=0.010)、组织学类型(χ2=11.23,P=0.004)、N分期(χ2=22.31,P<0.001)、组织学分级(χ2=12.86,P=0.005)，差异有统计学意义。二元逻辑回归结果显示，更大的诊断年龄(HR=1.302, 95%CI:1.101～1.541, P=0.002)、鳞癌(HR=1.353, 95%CI:1.059～1.728, P=0.016)、更高的N分期(HR=1.250, 95%CI:1.138～1.372,P<0.001)分别为影响NSCLC肝转移发生的独立危险因素。530例肝转移患者中位OS为4个月。Log-rank单因素生存分析显示，T分期(χ2=10.84, P=0.013)、组织学分级(χ2=20.04, P<0.001)、骨转移(χ2=11.25, P=0.001)、脑转移(χ2=14.85, P<0.001)、肺转移(χ2=27.46, P<0.001)、手术(χ2=11.05,P=0.004)、化疗(χ2=128.35, P<0.001)与患者1年总生存率有关。Cox回归分析结果显示，诊断年龄(HR=1.469,95%CI:1.074～2.010,P=0.003)，组织学分级(HR=1.427,95%CI:1.242～1.640,P<0.001)、骨转移(HR=1.425,95%CI:1.178～1.723,P<0.001)、脑转移(HR=1.353,95%CI:1.098～1.667,P=0.005)、肺转移(HR=1.450, 95%CI:1.168～1.799, P=0.001)、手术(HR=0.396, 95%CI:0.192～0.817, P=0.012)、化疗(HR=0.333, 95%CI:0.273～0.407, P<0.001)是NSCLC肝转移患者预后的独立影响因素。以此制作Nomogram，其C-index值为0.741。结论年龄、肿瘤组织学类型及N分期与晚期NSCLC患者发生肝转移密切相关。出现肝转移的患者中，确诊年龄较小、肿瘤组织学分级较高的NSCLC患者的预后相对较好，尽管对原发灶行手术及化学治疗能够延长患者的OS，但晚期NSCLC肝转移患者的整体预后不佳。该临床预测模型具有良好的预测价值。
Abstract：Objective To investigate the clinicopathological features in cases of advanced non-small cell lung cancer(NSCLC) with liver metastasis and the risk factors in prognosis. Methods The clinical data of NSCLC patients with distant metastases at initial diagnosis were collected from the Surveillance, Epidemiology, and End Results(SEER) database of the National Cancer Institute from January 1, 2010 to December 30, 2019. A total of 2 261 patients were divided into the liver metastasis group(n=530) and the non-liver metastasis group(n=1 731) according to the occurrence of liver metastasis. The clinicopathological characteristics of the two groups were analyzed by χ2 test and binary Logistic regression method, which obtained the independent risk factors for the occurrence of liver metastasis of NSCLC. Kaplan-Meier method was used to obtain the overall survival(OS) of the liver metastasis group. The Log-rank method and multivariate Cox regression model were used to analyze the prognosis, which obtained independent influencing factors for the prognosis of patients with NSCLC liver metastasis. The Nomogram figure was constructed by R software and consistency index(C-index) was calculated. Results The χ2 test showed that the following clinicopathological features including age of diagnosis, pathological type, N stage and histological grade were statistically significant different between the two groups(χ2=9.12, 11.23, 22.31, 12.86, all P<0.05). Binary Logistic regression showed that older age of diagnosis(HR=1.302, 95%CI: 1.101 ～ 1.541, P=0.002), squamous carcinoma(HR=1.386, 95%CI: 1.086 ～ 1.769, P=0.009) and higher N stage(HR=1.250, 95%CI: 1.138 ～ 1.372, P<0.001) were independent factors for liver metastasis. The median survival for 530 patients with liver metastasis was 4 months. According to Log-rank univariate survival analysis, T stage, histological grade, bone metastases, brain metastases, lung metastases, surgery and chemotherapy(χ2=10.84, 20.04, 11.25, 14.85, 27.46, 11.05, 128.35, all P<0.05) were significantly associated with 1-year survival mate. The results of Cox regression analysis showed that age of diagnosis, histological grade(HR=1.427, 95%CI: 1.242 ～1.640, P<0.001), bone metastases(HR=1.425, 95%CI: 1.178 ～ 1.723, P<0.001), brain metastases(HR=1.353, 95%CI: 1.098 ～ 1.667, P=0.005), lung metastases(HR=1.450, 95%CI: 1.168 ～ 1.799, P=0.001), surgery(HR=0.396, 95%CI: 0.192 ～ 0.817, P=0.012) and chemotherapy(HR=0.333, 95%CI: 0.273 ～ 0.407, P<0.001) were independent prognostic factors NSCLC in patients with liver metastasis. The study constructed a Nomogram with a C-index of 0.741. Conclusions Age, histological type, and N stage of tumors are closely related to the occurrence of liver metastasis in advanced NSCLC patients. Among those with liver metastasis, younger age and higher histological grade may indicate a better prognosis. Although surgery and chemotherapy can prolong survival, the overall prognosis for advanced NSCLC patients with liver metastasis remains poor. This nomogram provides a valuable tool for predicting the prognosis of such patients.
[1]Bray F,Laversanne M,Sung H,et al.Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2024,74(3):229-263.DOI:10.3322/caac.21834.
[2]Zhao J,Zhong J,Chen Y,et al.Molecular features of NSCLC patients with liver metastasis[J].Ther Adv Med Oncol,2024,16:17588359241275421.DOI:10.1177/17588359241275421.
[3]Siegel RL,Miller KD,Sauer AG.Colorectal cancer statistics,2020[J].CA Cancer J Clin,2020,70(3):145-164.DOI:10.3322/caac.21601.
[4]缪达，余岚，王启苑，等.肺癌罕见突变靶向治疗的现状及展望[J].中国肿瘤临床与康复，2025,32(2):97-126.DOI:10.13455/j.cnki.cjcor.113494-20241227-0378.
[5]Wei S,Wei W,Wu B,et al.The incidence and effect of different organ metastasis on the prognosis of NSCLC[J].Thorac Cardiovasc Surg,2024,72(3):217-226.DOI:10.1055/a-2146-6879.
[6]Zhang T,Zhang Y,Ni Y,et al.Construction of a nomogram model based on biomarkers for liver metastasis in non-small cell lung cancer[J].Thorac Cancer,2024,15(26):1897-1911.DOI:10.1111/1759-7714.15417.
[7]Krsti?V?，Samard?i?N,Gaji?M,et al.Treatment options for patients with non-small cell lung cancer and liver metastases[J].Curr Issues Mol Biol,2024,46(12):13443-13455.DOI:10.3390/cimb46120802.
[8]Thoracic Surgery Committee,Department of Simulated Medicine,Wu Jieping Medical Foundation.Chinese Experts Consensus on Artificial Intelligence Assisted Management for Pulmonary Nodule (2022 Version)[J].Zhongguo Fei Ai Za Zhi,2022,25(4):219-225.DOI:10.3779/j.issn.1009-3419.2022.102.08.
[9]Deng JY,Gou Q,Yang L,et al.Immune suppressive microenvironment in liver metastases contributes to organspecific response of immunotherapy in advanced nonsmall cell lung cancer[J].J Immunother Cancer,2023,11(7):e007218.DOI:10.1136/jitc-2023-007218.
[10]Choi MG,Choi CM,Lee DH,et al.Different prognostic implications of hepatic metastasis according to front-line treatment in non-small cell lung cancer:a real-world retrospective study[J].Transl Lung Cancer Res,2021,10(6):2551-2561.DOI:10.21037/tlcr-21-206.
[11]Wang JF,Lu HD,Wang Y,et al.Clinical characteristics and prognosis of non-small cell lung cancer patients with liver metastasis:a population-based study[J].World JClin Cases,2022,10 (30):10882-10895.DOI:10.12998/wjcc.v10.i30.10882.
[12]Tsilimigras DI,Brodt P,Clavien PA,et al.Liver metastases[J].Nat Rev Dis Primers,2021,7(1):27.DOI:10.1038/s41572-021-00261-6.
[13]Wang X,Niu X,An N,et al.Comparative efficacy and safety of immunotherapy alone and in combination with chemotherapy for advanced non-small cell lung cancer[J].Front Oncol,2021,11:611012.DOI:10.3389/fonc.2021.611012.
[14]Funazo T,Nomizo T,Kim YH.Liver metastasis is associated with poor progression-free survival in patients with non-small cell lung cancer treated with nivolumab[J].J Thorac Oncol,2017,12(9):e140-e141.DOI:10.1016/j.jtho.2017.04.027.
[15]孙家齐，王玉栋.非小细胞肺癌肝转移免疫微环境研究进展及治疗策略[J].肿瘤防治研究，2024,51(3):203-209.DOI:10.3971/j.issn.1000-8578.2024.23.0878.
[16]Tournoy KG,Thomeer M,GermonpréP,et al.Does nivolumab for progressed metastatic lung cancer fulfill its promises?An efficacy and safety analysis in 20 general hospitals[J].Lung Cancer,2018,115:49-55.DOI:10.1016/j.lungcan.2017.11.008.
[17]?nal?，Ko?er M,Ero?lu HN,et al.Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer[J].Turk J Med Sci,2020,50(8):1838-1850.DOI:10.3906/sag-1912-205.
[18]Yu J,Green MD,Li S,et al.Liver metastasis restrains immunotherapy efficacy via macrophage-mediated T cell elimination[J].Nat Med,2021,27(1):152-164.DOI:10.1038/s41591-020-1131-x.
[19]Li Y,Wong M,Zhan L,et al.Single organ metastatic sites in non-small cell lung cancer:patient characteristics,treatment patterns and outcomes from a large retrospective Canadian cohort[J].Lung Cancer,2024,192:107823.DOI:10.1016/j.lungcan.2024.107823.
[20]Liu YT,Sun M,Xiong Y,et al.Construction and validation of prognosis nomogram for metastatic lung squamous cell carcinoma:a population-based study[J].Technol Cancer Res Treat,2022,21:15330338221132035.DOI:10.1177/15330338221132035.
[21]Sato H,Demaria S,Ohno T.The role of radiotherapy in the age of immunotherapy[J].Jpn J Clin Oncol,2021,51(4):513-522.DOI:10.1093/jjco/hyaa268.
[22]姜赢，童旭，毕楠.现代放射治疗技术和免疫治疗背景下剂量分割模式在肺癌根治性放疗中的应用[J].中国肿瘤临床与康复，2025,32(2):67-77.DOI:10.13455/j.cnki.cjcor.113494-20241203-0327.
[23]Shen Y,Xi F,Zhao P,et al.Development and validation of a prognostic nomogram for ovarian clear cell carcinoma:a study based on the SEER database and a Chinese cohort[J].Discov Oncol,2025,16(1):482.DOI:10.1007/s12672-025-02272-1.
基本信息:
DOI：10.13455/j.cnki.cjcor.113494-20250412-0157
中图分类号:R734.2
引用信息:
[1]张鹏,万谦,罗静,等.晚期非小细胞肺癌肝转移患者的临床病理特征及预后因素分析[J].中国肿瘤临床与康复,2025,32(11):701-712.DOI:10.13455/j.cnki.cjcor.113494-20250412-0157.
基金信息:
国家自然科学基金面上项目（82273325）~~