伽玛刀治疗肺癌脑转移瘤的远期生存分析  

Long-term survival analysis for patients with brain metastases of pulmonary cancer undergoing Gamma Knife surgery

作　　者：俞建臣[1] 汤可[1] 赵亚群[1] 赵莉[1] 高冬晓[1] 高浩[1] 

机构地区：[1]解放军第309医院神经外科,北京100091

出　　处：《中国医学装备》2015年第5期16-19,共4页China Medical Equipment

基　　金：首都卫生发展科研专项(2014-4-5073)"计算机桥小脑角区手术虚拟现实微创化检验和临床实践"

摘　　要：目的:分析肺癌脑转移瘤行伽玛刀治疗患者的临床资料,探讨远期生存的影响因素。方法:收集132例肺癌脑转移瘤患者的临床资料,记录患者年龄、性别、肺癌病理类型、转移瘤的部位、大小、数目以及是否颅外转移,对治疗前卡氏性能量表(KPS)和概率风险评估(PRA)进行评分,同时记录原发灶与脑转移瘤诊断时间间隔等资料。采用log-rank方法进行远期生存的单因素分析,通过Cox回归模型进行多因素远期生存分析。结果:患者中位生存时间为22个月,12个月累计生存率为66.67%,24个月累计生存率为26.52%,36个月累计生存率为9.85%,48月累计生存率为1.52%。Log-rank统计分析显示,病理类型、转移瘤部位、转移瘤数目、是否颅外转移以及治疗前KPS和RPA评分等对伽玛刀术后远期生存影响差异有统计学意义。Cox回归模型显示,颅外转移和治疗前RPA评分是影响远期生存率的独立危险因素。结论:注重颅外肿瘤的控制,配合有效的伽玛刀治疗是改善肺癌脑转移瘤患者远期预后的关键所在。Objective： To analyze the clinical characteristics of patients with brain metastases of pulmonary cancer undergoing Gamma Knife radiosurgery and discuss the influencing factors of long-term survival. Methods： The clinical characteristics of 132 cases with brain metastases of pulmonary cancer undergoing Gamma Knife surgery were collected retrospectively. Age, gender, pathological type, position, size, quantity, extracranial metastases, KPS and PRA score before radiosurgery, and interval of diagnosis between primary lesion and brain metastases were recorded. Log-rank method and Cox regression model were employed to perform univariate and multivariate analysis respectively for long-term survival. Results： Median survival time was 22 months and accumulative survival rate was 66.67%at 12 months, 26.52%at 24 months, 9.85%at 36 months, 1.52%at 48 months, respectively. Pathological type, position, quantity, extracranial metastases, KPS and PRA score before radiosurgery, et al were revealed as the factors significantly related to long-term survival by log-rank analysis. Then, extracranial metastases and PRA score before radiosurgery were shown as independent predictors for long-term survival by Cox regression model. Conclusion：Primary tumor controlling actively combined with effective Gamma Knife radiosurgery plays a predominant role to improve the long-term prognosis for patients with brain metastases of pulmonary cancer.

关 键 词：脑转移瘤 肺癌 伽玛刀 随访 预后 

分 类 号：R734.2[医药卫生—肿瘤]