Background: A number of patients with lung cancer have distant metastases at the time of diagnosis. The most common sites for metastases are liver, brain, etc. However pancreatic metastasis is relatively rare, with an insidious onset and poor prognosis. There are no sufficient recognition and attention of lung cancer with pancreatic metastasis. The aim of this study was to summarize the pathological characteristics, clinical manifestations, therapies and prognosis of pancreatic metastases of lung cancer, thus further exploring better managements for the best prolonged survival or quality of life.
Methods: 42 patients of lung carcinoma with confirmed pancreatic metastases hospitalized at the Peking Union Medical College Hospital from January 1998 to December 2018 were identified. We reviewed all medical documentations for complete information including diagnosis, treatment, prognosis features.
Results: 24 (57%) patients were asymptomatic or presented with non-specific symptoms. 18 (43%) patients had symptoms related to pancreatic metastases, such as acute pancreatitis, obstructive jaundice or pain of lumber back. The median overall survival (OS) was 8.8 months. Multivariate analysis suggested patients with symptoms had a poor prognosis compared with patients without pancreatic symptoms [(hazard ratio, HR)=2.645, 95%CI: 1.013-6.910, P=0.047]. Patients received chemotherapy had better prognosis versus those who did not [HR=0.158, 95%CI: 0.049-0.512, P=0.002].
Conclusions: Pancreatic metastasis of lung cancer is rare and the prognosis is poor. Chemotherapy can prolong survival significantly. Local radiotherapy of the pancreas may alleviate local symptoms, improve quality of life, facilitate further systemic chemotherapy for patients to prolong survival. Patients with symptoms related to pancreatic metastases can benefit from the comprehensive treatment of chemotherapy combined with local pancreatic radiotherapy.
【中文题目：肺癌伴胰腺转移42例临床分析】 【中文摘要：背景与目的 多数肺癌患者在诊断时即出现远处转移，常见的转移部位包括肝脏、脑等，其中胰腺转移较为罕见。胰腺转移起病隐匿，预后普遍较差。目前医生对其的认识程度和重视程度不足。本研究旨在分析肺癌胰腺转移患者的病理特征、临床表现、治疗方案、预后以及相关因素对生存期的影响，探讨延长肺癌伴胰腺转移患者生存期及改善其生活质量的最佳治疗方案。方法 回顾性分析自1998年1月-2018年12月于北京协和医院就诊的42例信息资料完整的肺癌胰腺转移患者。结果 24例患者（57%）无特异性胰腺转移症状，18例患者（43%）出现胰腺转移相关症状，表现为腰背痛、急性胰腺炎、梗阻性黄疸。中位总生存期（overall survival, OS）为8.8个月。经多因素分析，存在急性胰腺炎等症状的患者预后偏差[危险比（hazard ratio, HR）=2.645，95%CI: 1.013-6.910，P=0.047]。胰腺转移后接受化疗的患者预后明显优于未接受化疗治疗的患者[HR=0.158, 95%CI: 0.049-0.512, P=0.002]。结论 肺癌胰腺转移罕见，预后差，存在胰腺相关症状者相对更差。接受化疗治疗能明显延长患者生存期。胰腺的局部放疗治疗可以缓解局部症状，利于患者进一步接受化疗治疗。有胰腺转移灶症状的患者可从化疗联合胰腺局部放疗的综合治疗中受益。】 【中文关键词：肺肿瘤；胰腺转移；急性胰腺炎；梗阻性黄疸；化疗治疗；局部放疗】.
Keywords: Acute pancreatitis; Chemotherapy; Local radiotherapy; Lung neoplamsms; Obstructive jaundice; Pancreatic metastasis.