局部晚期非小细胞肺癌脑转移危险因素研究  

Study on risk factors of brain metastases of locally advanced non-small-cell lung cancer

作　　者：曹霞[1] 汪安兰[2] 杨锫[1] 袁媛[1] 吴胜其[3] 罗荣喜[1] 

机构地区：[1]湖南省肿瘤医院放疗科,长沙410013 [2]湖南省肿瘤医院肿瘤内科,长沙410013 [3]湖南省肿瘤医院科教部,长沙410013

出　　处：《肿瘤研究与临床》2012年第1期24-27,共4页Cancer Research and Clinic

摘　　要：目的探索并选定局部晚期非小细胞肺癌（LA－NSCLC）预防性脑照射目标人群。方法回顾性分析2006年6月至2010年10月收治的114例LA－NSCLC患者资料，选择其中相关病例分析脑转移高危因素及相关特点。结果2年脑转移率31．58％（36／114），脑转移首发的发生率为20．18％（23／114）。孤立脑转移的发生率为9．65％（11／114）。二值Logistic回归分析进入方程的变量为病理类型（OR=5．892）和治疗方式（OR=2．888），非鳞状细胞癌和单一治疗方式的患者脑转移率高（P〈0．01），模型拟合度好（P〉0．05）。预测脑转移的总正确率为67．7％。脑转移或死亡病例乳酸脱氢酶增高率（17．54％）较无脑转移并生存病例（0）高（P〈0．01），同时显示纵隔淋巴结转移组数与个数呈正相关（r=0．716，P〈0．01），腺癌较鳞状细胞癌脑转移或死亡率高（P〈0．01），且有更多的纵隔淋巴结转移（P〈0．05）。鳞状细胞癌及腺癌肿瘤最大直径均数分别为5．8em和3．9em（P〈0．01）。结论LA-NSCLC患者单一治疗方式脑转移发生率高。原发肿瘤大、乳酸脱氢酶高、非鳞状细胞癌、多站及多个纵隔淋巴结转移可作为脑转移相关危险因素进行预防性脑照射研究。Objective To evaluate the prognostic factors in locally advanced non-small-cell lung cancer （LA-NSCLC） for selectively carrying out prophylactic cranial irradiation （PCI）. Methods 114 patients with LA-NSCLC between Jun 2006 and Oct 2010 were retrospectively analyzed. Related risk factors and features about brain metastases were analyzed. Results The 2-year incidence rate of brain metastases was 31.58 % （36/114）, the first brain metastases was 20.18 % （23/114）, and sole brain metastases was 9.65 % （11/114）, respectively. Variables involved in the equation of binary logistic regression analysis were pathology （OR = 5.892） and treatment mode（OR = 2.888）. The incidence rate of brain metastases in patients of non-squamous carcinoma and single treatment mode was higher than others （P 〈 0.01） Model fitting is better （P 〉 0.05）. Overall accuracy rate of predicting brain metastases is 67.7 %. The increased rate of lactate dehydrogenase in the patients with brain metastases or death was 17.54 %, which was higher than that in the survival patients without brain metastases （P 〈 0.01）. At the same time, the station number and the number of mediastinal lymph node metastases were positively correlated （r = 0.716, P 〈 0.01）. The incidence rate of brain metastases or mortality rate was higher in the adenocarcinoma cases than that in the squamous carcinoma cases （P 〈 0.01, P 〈 0.05）, with more frequent occurrence of mediastinal metastases. The mean diameter of sqnamous carcinoma and adenocarcinoma were 5.8 cm and 3.9 cm, respectively （P 〈 0.01）. Conclusions The incidence rate of brain metastases was higher in patients with single treatment. Large primary tumors, high lactate dehydrogenase, non-squamous carcinoma, multiple stations, and multiple mediastinal lymph nodes metastases can be regarded as risk factors of brain metastases to perform PCL

关 键 词：癌 非小细胞肺 肿瘤转移 危险因素 

分 类 号：R734.2[医药卫生—肿瘤]