非小细胞肺癌脑转移瘤综合治疗的预后影响因素分析

目的:研究综合治疗的非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移瘤患者生存预后影响因素,为NSCLC脑转移瘤的治疗提供更多的参考依据。方法:收集83例诊断为NSCLC脑转移瘤的患者进行回顾性研究,随访后建立临床资料数据库,采用单因素分析及Cox回归模型分析不同因素对非小细胞肺癌脑转移瘤患者生存期的影响。结果:患者中位生存期为11个月,6月、12月、18月的生存率分别为79.0%、32.7%、19.4%。经单因素和多因素分析结果显示脑转移瘤的病理类型、原发灶控制情况、治疗方式、靶向治疗是NSCLC脑转移生存的独立影响预后因素。单发转移瘤中,手术联合全脑放疗(Whole brain radiotherapy,WBRT)与手术相比风险率(hazard rate,HR)为0.645(P>0.05),说明联合方式并没有在生存中获益。多发转移瘤中,手术与WBRT相结合与单纯手术对比HR=0.297(P<0.05),有统计学意义。结论:病理类型为非腺癌,原发灶未得到控制,治疗方式不当以及未应用靶向治疗是NSCLC脑转移瘤的独立危险因素。对于单发脑转移瘤患者的局部治疗,单独手术治疗可能具有更高的优势;对于多发脑转移瘤患者的局部治疗,手术与WBRT联合可能具有更多的生存获益。

Prognostic Analysis of Comprehensive Treatment for Brain Metastases from Non-small Cell Lung Cancer

ABSTRACT Objective: To study the factors influencing the survival and prognosis of patients with non-small cell lung cancer (NSCLC) brain metastases, and provide more references for the treatment of NSCLC brain metastases. Methods: 83 cases of NSCLC patients with brain metastases were collected for the neurosurgery department of Tumor Hospital affiliated Harbin Medical University from 2014 to 2017. The follow-up rate was 97.6% (81/83). After follow-up, a clinical data database was established. Univariate analysis and Cox regression model were used to analyze the impact of different factors on the survival of patients with NSCLC brain metastases. Results: The median survival time of patients was 11 months, and the 6, 12 and 18 month survival rates were 79.0%, 32.7% and 19.4%, respectively. The results of univariate and multivariate analysis showed that the pathological type, primary tumors, treatment and targeted therapy of brain metastases are independent prognostic factors for the survival of NSCLC brain metastases. For the single metastatic tumor, the operation combined with (Whole brain radiotherapy) WBRT compared with the operation, the hazard rate (HR) is 0.645(P>0.05), indicating that the combination did not benefit survival. For the multiple metastatic tumors, the comparison between surgery combined with WBRT and surgery alone was statistically significant (HR=0.297, P<0.05). Conclusion: The pathologic type being non-adenocarcinoma, primary lesion uncontrolled, treatment method and failure to apply targeted therapy are independent risk factors for NSCLC brain metastases. For the local treatment of patients with single brain metastases, surgery combined with WBRT did not get survival benefit compared with simple surgery, suggesting that for patients with single brain metastases, the local treatment alone may have higher advantages. For the local treatment of patients with multiple brain metastases, surgery combined with WBRT may have more survival benefits than simple surgery.