单纯脑寡转移的初治非小细胞肺癌患者预后相关因素分析

Survival prognostic factors for non-small cell lung cancer patients with brain-only oligometastases

关键词:  非小细胞肺癌  脑寡转移  预后因素

Key words:  non-small cell lung cancer  brain-only oligometastases  prognostic factors

摘要:

目的　分析单纯脑寡转移的初治非小细胞肺癌患者临床特征及治疗模式，探讨影响患者预后的相关因素。方法　收集2005年1月至2014年12月大连医科大学附属第一医院治疗的晚期非小细胞肺癌患者，均为初诊单纯脑寡转移病例41例。对年龄、性别、KPS评分、GPA评分、原发病灶病理类型、脑转移病灶数量、脑转移病灶最大径、脑转移灶局部治疗模式、肺内病灶控制情况、全身治疗模式等因素应用Log-rank检验进行单因素分析，多因素分析采用Cox回归模型，Kaplan-Meier法分析生存情况。结果　全组患者中位生存时间8.9个月，1年、2年生存率分别为41.5%、14.6%。单因素分析提示：脑转移病灶数量、脑转移治疗模式、全身治疗模式与预后相关，多因素分析结果提示靶向治疗是唯一独立预后相关因素。结论　对于初诊即存在脑寡转移的非小细胞肺癌患者，寡转移病灶的数量、脑转移治疗模式、全身治疗模式为预后相关因素，其中全身治疗模式即是否应用靶向治疗为唯一独立预后相关因素。

Abstract:

Objective In order to look for the factors that affect the prognosis of non-small cell lung cancer (NSCLC) patients with brain-only oligometastases. Methods In this research, there were 41 patients diagnosed with advanced non-small cell lung cancer and with brain-oly oligometastasis, from January 2005 to December 2014, in the first affiliated hospital of dalian medical university. The entry criteria includes: (1)Pulmonary lesions were confirmed by histological. (2)Enhanced brain MRI confirmed brain metastasis with 1-5 lesions. (3)No other metastases except for brain. (4) The primary lung lesions were effectively treated.(5)KPS score ≥ 60 points. Log-rank test, Cox regression model and Kaplan-Meier survival analysis were used to analyze the effect of the age, gender, KPS score, GPA score, primary tumor pathological type, number of brain metastases, metastatic brain lesions size, range of local treatment mode of brain metastasis and lung lesions control to prognosis. Results In these 41 patients, the median survival time was 8.9 months. The 1 year and 2-year survival rates were 41.5% and 14.6% respectively. Log-rank analysis showed that the number of brain metastases, the local treatment mode of brain metastases, and the patterns of systemic treatment were related to prognosis. Cox regression model suggested that systemic treatment mode is the only independent prognostic factors. Conclusion The number of metastatic lesions, local treatment model of brain metastases, and systemic treatment model would affect the prognosis of NSCLC patients with brain-only oligometastases. Target therapy showed a good prognosis.