非小细胞肺癌脑转移瘤不同治疗方法的疗效评价以及预后分析  

Effects of different treatment modality on non-small-cell lung cancer with brain metastases and factors related to the prognosis

作　　者：孙红梅[1] 陈文彰[1] 燕丽香[1] 徐广萍 常中飞[1] 杨云鹏[1] 鲍云华[3] 

机构地区：[1]首都医科大学石景山教学医院(北京市石景山医院)肿瘤科,北京100043 [2]南阳市油田总医院妇产科,河南南阳473132 [3]解放军307医院肿瘤中心,北京100071

出　　处：《现代肿瘤医学》2013年第3期568-572,共5页Journal of Modern Oncology

摘　　要：目的:评价非小细胞肺癌脑转移瘤患者接受不同治疗方法的疗效和生存预后因素。方法:分析2009年8月-2012年2月我科收治的71例肺癌脑转移患者的临床特点,用SPSS16.0软件进行统计学分析,Kap-lan-Meier法和Log rank法分析比较生存期,Cox模型进行多因素回归分析,非参数检验根据Mann-WhitneyU方法比较脑局部控制率。结果:单因素分析结果提示脑部放疗方式、原发灶治疗方式、T分期、KPS评分、颅外转移数目对患者生存期有影响(P<0.05)。Cox模型多因素分析显示脑转移瘤不同治疗方案为独立预后因素(P=0.0001)。71例病例中20例(28.2%)给予单纯脑部放疗,13例(18.3%)给予单纯全身化疗,16例(22.5%)进行脑部放疗+全身化疗联合治疗,22例(31.0%)仅给予最佳支持治疗。放化疗联合治疗在脑部局部控制率(62.5%)均优于单纯全身化疗(15.4%)以及单纯全脑放疗(35.0%,P=0.0002),且在中位生存期(37.1个月)明显优于单纯全身化疗(8.7个月)以及单纯全脑放疗(18.8个月,P=0.0003)。结论:脑转移瘤不同治疗方案是影响预后的独立因素,在患者身体条件允许情况下,全脑放疗联合多学科综合治疗为最佳治疗模式。Objective：To investigate the effects of different treatment modality on non -small -cell lung cancer with brain metastases and factors related to the prognosis. Methods：From August 2009 to February 2012, there were 71 lung cancer patients with brain metastases. Statistical analysis was performed using the Kaplan - Meier method and Cox - regression analysis, and nonparametric test was performed by using Mann - Whitney U method to compare local brain tumor response rate. Results：Univariate analysis showed the following variables bad effect on survival：the treat- ment modality of brain metastases, treatment of primary site of lung cancer, T stag of the tumor, KPS scores, number of extra cranial metastases（P 〈 0.05 ）. Based on Cox- regression analysis, treatment modality of brain metastases was the only independent predictor of survival. Of the 71 cases, 20 （28.2%） cases were treated with whole brain radio- therapy（WBRT） alone; 13 （ 18.3 % ） cases were treated with system chemotherapy alone; 16 （ 22.5 % ） cases were treated with WBRT combined with system chemotherapy. 22（31.0% ） cases were given best supportive care. Local brain response rate, evaluated one month after treatment, differed significantly in radio - chemotherapy group （62.5%） compared with system chemotherapy alone （15.4%） and WBRT alone（35.0%, P = 0. 0002 ）. And medi- um survival time differed significantly in radio - chemotherapy group （37.1 months） compared with system chemo- therapy alone （ 8.7 months） and WBRT alone （ 18.8 months, P = 0. 0003 ）. Conclusion ： Treatment modality of brain metastases was the only independent predictor of survival. Aggressive combined therapy of brain metastases may a- chieve a survival advantage. It is proposed to provide combined therapy of whole brain radiotherapy and other diverse therapy in patients of good quality status.

关 键 词：肺肿瘤 脑肿瘤 肿瘤转移 总生存率 

分 类 号：R734.2[医药卫生—肿瘤] R73-37[医药卫生—临床医学]