文章：

弥漫性转移与局部大块型肺癌的临床及生物学特征差异：德国某大学癌症中心的真实世界研究结果

Distinct Clinical and Biological Features of Diffusely Metastatic Versus Bulky Localized Lung Cancer: Real-World Outcomes from a University Cancer Center in Germany

原文发布日期：21 November 2025

DOI: 10.3390/cancers17233728

类型: Article

开放获取: 是

英文摘要：

Background:Lung cancer metastasis results from local invasion, loss of adhesion, migration, and distant implantation. Some small tumors metastasize diffusely other tumors progress to local bulky disease without metastasis. Here we compare these biologically divergent courses of progression and present an analysis of clinical features related to early diffuse metastasis vs. bulky disease.Methods: We retrospectively collected data from pathologically confirmed not-metastatic “bulky” (cT3-T4cN0cM0) or “diffusely metastatic” (cT1-T2cN1-3cM1) patients with lung cancer treated at our center from 2013 to 2023. Clinical data including sex, age, histology, ECOG-PS, tumor stage, smoking status, presence, and site of metastases, LDH, CRP, NLR ratio were collected.Results: A total of 375 patents with “bulky” (n= 95) or diffusely metastatic lung cancer (n= 280) were included in the analysis. In the univariate analysis, the diffusely metastatic population was younger (p= 0.001), had a higher proportion of never smokers (p= 0.02), histologically adenocarcinoma (p< 0.0001), TTF1 positive (p< 0.00001) and elevated baseline LDH in serum (LDH > 250U/l,p< 0.0001) compared to “bulky” population. Patients with diffuse metastatic disease presented worse OS (HR = 2.34,p= 0.0001) and PFS (HR = 6.89,p< 0.0001) compared to patients with bulky disease.Conclusions: Younger age, never smokers, TTF1 positivity, poorly differentiated tumors, adenocarcinoma histology were independently associated with risk of distant metastasis.

摘要翻译： 

背景：肺癌转移源于局部侵袭、黏附丧失、迁移及远处种植。部分小型肿瘤发生弥漫性转移，而另一些肿瘤则进展为局部大块病变但无转移。本研究比较了这两种生物学进展路径的差异，并分析了与早期弥漫性转移及大块病变相关的临床特征。 方法：回顾性收集2013年至2023年间在本中心接受治疗、经病理确诊的非转移性“大块型”（cT3-T4cN0cM0）或“弥漫转移型”（cT1-T2cN1-3cM1）肺癌患者数据。收集的临床资料包括性别、年龄、组织学类型、ECOG-PS评分、肿瘤分期、吸烟状况、转移部位、乳酸脱氢酶（LDH）、C反应蛋白（CRP）及中性粒细胞与淋巴细胞比值（NLR）。 结果：共纳入375例患者，其中“大块型”95例，弥漫转移型280例。单因素分析显示，与“大块型”患者相比，弥漫转移型患者更年轻（p=0.001）、从不吸烟者比例更高（p=0.02）、组织学类型以腺癌为主（p<0.0001）、TTF1阳性率更高（p<0.00001），且血清基线LDH水平更高（LDH＞250U/L，p<0.0001）。弥漫转移型患者的总生存期（HR=2.34，p=0.0001）和无进展生存期（HR=6.89，p<0.0001）均较大块型患者更差。 结论：年轻、从不吸烟、TTF1阳性、低分化肿瘤及腺癌组织学类型与远处转移风险独立相关。

原文链接：

Distinct Clinical and Biological Features of Diffusely Metastatic Versus Bulky Localized Lung Cancer: Real-World Outcomes from a University Cancer Center in Germany