| 许亚萍,马胜林,季永领,余新民,俞洋,孙晓江,王升晔.非小细胞肺癌脑转移不同治疗方法的疗效分析[J].中华放射医学与防护杂志,2009,29(1):71-74 |
| 非小细胞肺癌脑转移不同治疗方法的疗效分析 |
| The analysis of effect about different therapies on brain metastases from non-small cell lung cancer |
| 投稿时间：2008-07-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2009.01.022 |
| 中文关键词: 肺肿瘤 肿瘤转移 脑 综合疗法 预后 |
| 英文关键词:Lung neoplasms Neoplasm metastasis Brain Combined modulated therapy Prognosis |
| 基金项目: |
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| 摘要点击次数: 2837 |
| 全文下载次数: 1943 |
| 中文摘要: |
| 目的 回顾性分析非小细胞肺癌脑转移预后因素,探讨以全脑放疗为主的不同方案多学科综合治疗的疗效。方法 4年中共收治非小细胞肺癌脑转移患者 251例,其中行全脑放疗联合其他多学科治疗患者183例。分析这183例患者临床特点,结合随访资料进行预后因素分析,用Kaplan-Meier 法和Logrank 法分析比较生存率, 用Cox 模型进行多因素回归分析。结果 全组中位生存时间10.0个月。1、2、3年生存率分别为40.6%、16.6%、11.3%。Cox 模型多因素分析显示RPA分级、体重下降与否、血清LDH是否升高和不同的多学科治疗方案为独立预后因素。多因素和单因素生存分析均提示治疗方案明显影响预后。对单个颅内转移灶患者开颅手术+术后放化疗预后好,中位生存期达22个月;全脑放疗联合分子靶向治疗中位生存期达13个月;全脑放疗联合化疗与单纯全脑放疗中位生存期相似均为9个月;对97例全脑放疗联合化疗患者分层分析提示同期放化疗疗效优于序贯放化疗,中位生存期分别为13个月和9个月(χ2=3.89,P=0.049)。结论 RPA分级、体重下降与否、血清LDH水平是影响非小细胞肺癌脑转移患者预后的重要因素。治疗方案影响预后,积极的多学科综合治疗疗效优于单纯全脑放疗。对于一般情况较好能耐受手术的单发脑转移患者,开颅手术+术后放化疗是一种较好的治疗手段。 |
| 英文摘要: |
| Objective To evaluate the prognostic factors of brain metastasis from non-small cell lung cancer and suggest a individualized treatment method proposal with prognostic estimation.Methods From Dec.2003 to Jan.2007, 183 patients received whole brain radiation therapy (WBRT) were retrospectively analyzed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall 1-, 2- and 3-year survival rate was 40.6%, 16.6% and 11.3%, respectively, but with a median survival time of 10.0 months (95% CI 8.6-11.4 months). In multivariate analysis, RAP grouping, weight loss, LDH in blood serum and treatment method were independent prognostic factors. The median survival time of WBRT alone, WBRT with chemotherapy, surgery with chemoradiotherapy and WBRT with Gefitinib was 9.0, 9.0, 22.0 and 13.0 months, respectively, but their difference were statistical significant (χ2=10.37, P=0.016). Conclusion The main prognostic factors of brain metastasis from non-small cell lung cancer are RAP grouping, weight loss, LDH in blood serum and treatment method. The survival time is prolonged by proper multidisciplinary management than WBRT alone. The effect of combined treatment of surgery with chemoradiotherapy is favorable for the patients operated with single region of metastasis. |
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