원발성 폐암에 동반된 과칼슘혈증에 대한 임상적 고찰

Abstract

Objectives: The humoral hypercalcemia of malignancy(HHM) describes a very specific clinical syndrome due to the production of a peptide or family of peptide hormones which share sequence homology and functional homology with parathyroid hormone. Patients with HHM account for up to 80 percent of malignancy-associated hypercalcemia. The hypercalcemia in lung cancer is mainly mediated by parathyroid hormone-related protein. Typical patients with HHM had little or no skeletal involvement. Hypercalcemia is predominantly associated with epidermoid and large cell anaplastic carcinoma. From a clinical standpoint, patients with hypercalcemia are usually in advanced stages with obviously bulky tumors and, therefore, carry a poor prognosis. Methods: Between January 1987 and November 1993, the patients those who fulfilled the following criteria were chosen as a subjects in this study: ① corrected serum calcium >10.5mg/dl; ② histologically proven primary lung cancer; ③ symptoms which could possibly be attributed to hypercalcemia. We investigated the various clinical features that could characterize the hypercalcemia in lung cancer. Results: Thirty-one patients with lung cancer were hypercalcemic and most of them had squamous cell carcinoma in histologic finding. The incidence between 50 and 69 years of age was higher significantly. The occurrence of hypercalcemia showed a strong positive correlation with the degree of histologic differentiation and the advancement of cancer stage. And the mean serum calcium level also showed a strong positive correlation with the mass size and the performance scale. Some symtoms such as general weakness, anorexia, constipation, consciousness change, and weight loss were more frequent in the patients of higher calcium level. There was no significant difference in effectiveness among the therapeutic regimens for hypercalcemia. Most of patients were hypercalcemic at the time that the diagnosis of lung cancer was made. Most of them died within 1 month after the development of hypercalcemia. Conclusion: The hypercalcemia in lung cancer was found more frequently in men whose ages were between 50 and 69 years old, and in the patients who had poorly differentiated squamous cell carcinoma or the carcinoma in advanced stage. Mean serum calcium level was higher in more symptomatic patients, and in the patients with worse performance scale or larger tumor mass. The prognosis of hypercalcemic patients with lung cancer was extremely poor.