脑转移对吉非替尼治疗有效NSCLC患者生存期和生活质量的影响  

The effect of brain metastasis on survival and quality of life of patients with effective treatment of gefitinib

作　　者：陈婷婷[1] 陈振东[1] 王年飞[1] 李娜[1] 李飞[2] 

机构地区：[1]安徽医科大学第二附属医院肿瘤中心,合肥230601 [2]安徽省立新安医院肿瘤科,合肥230022

出　　处：《安徽医科大学学报》2013年第6期656-659,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的观察吉非替尼治疗非小细胞肺癌(NSCLC)有效超过6个月后,脑转移对患者生存期及生活质量的影响。方法依据核磁共振(MRI)判断有无脑转移,伴有脑转移患者为试验组,无脑转移患者为对照组。试验组给予吉非替尼250 mg/d治疗加或不加颅脑放疗,对照组给予吉非替尼250mg/d治疗。比较两组的总生存期(OS)、无进展生存期(PFS)、生活质量(QOL)和认知障碍。结果试验组纳入27例,其中22例在吉非替尼治疗前、5例在吉非替尼治疗后出现脑转移,对照组61例。试验组及对照组的OS[(22.50±10.50)个月vs(21.95±12.75)个月]、PFS[(17.24±10.76)个月vs(16.15±11.78)个月]比较,差异无统计学意义。试验组和对照组患者1、2、3年生存率分别为85.0%vs82.6%、35.0%vs 39.1%和15.0%vs 10.9%,差异均无统计学意义。治疗过程中出现脑转移患者行为状态评分(KPS评分)下降不明显。对照组和试验组分别有2例(3.3%)、9例(33.3%)出现认知障碍。结论在肺部病灶能被吉非替尼控制的背景下,脑转移不是影响患者后续生存期及生活质量的主要因素;吉非替尼治疗NSCLC过程中出现脑转移不宜简单地视为"病情进展"而更换治疗方案,原药继续治疗配合颅脑放疗仍然有效;脑转移患者的认知障碍值得重视。Objective To observe the effect of brain metastasis on survival and quality of life of the patients whose non-small cell lung cancer（NSCLC） have been effectively treated by gefitinib for over six months. Methods Brain metastasis was identified based on MRI. The patients with brain metastasis was taken as experiment group, and those without brain metastasis as control. The experiment group was treated with gefitinib with or without brain radiotherapy, while the control group received gefitinib only. The two groups were compared from such aspects as overall survival （OS）, progression-free survival （PFS）, the quality of life（QOL）, and cognitive disorder. Results There were 27 cases in the experiment group （22 of them had brain metastasis before gefitinib treatment and 5 of them had brain metastasis after gefitinib） and 61 cases in the control group, there was no statistically significant difference showed in the OS E （ 22.50 ± 10.50） months vs （21.95 ± 12. 75 ） months ] and PFS [ （ 17.24 ± 10.76） months vs （16. 15 ± 11.78） months] of the two groups. Two groups＇1-,3-,5- years survival rate were 85% vs 82. 6% ,35% vs 39. 1%, and 15.0% vs 10. 9%, respectively,which showed no statistical significance. Karnofsky performance status did not decrease significantly when brain metastasis was detected during the treatment procedure. Two cases （3.3%） in the control group was noted, but not in 9 cases （33.3%） in the experiment group. Conclusion As regard to patients whose pulmonary lesion could be controlled by gefitinib, brain metastasis is not the main factor affecting the following lives time and the quality of lives of the patients. During the treatment procedure of NSCLC with gefitinib, the brain metastases should not be simply regarded as the disease progression to change the treatment plan, continuous treatment by gefitinib in combination with brain radiotherapy was still effective. Attention should be paid to the cognitive disorder of the patients with brain metastases.

关 键 词：非小细胞肺癌 脑转移 吉非替尼 总生存期 生活质量 认知障碍 

分 类 号：R734.2[医药卫生—肿瘤]