伽玛刀治疗非小细胞肺癌脑转移瘤预后指标评价  

Evaluation for prognostic indices of brain metastases from non-small cell lung cancer after gamma knife treament

作　　者：高红祥 张晓智[1] 党亚正[2] 康文星[2] 

机构地区：[1]西安交通大学第一附属医院放疗中心,陕西西安710061 [2]解放军第323医院放疗中心,陕西西安710054

出　　处：《西部医学》2015年第9期1344-1348,共5页Medical Journal of West China

基　　金：陕西省自然科学基金(2010JM4053)

摘　　要：目的评价不同预后评级系统对伽玛刀治疗非小细胞肺癌(NSCLS)脑转移瘤的生存及预后预测的有效性。方法回顾性分析76例行伽玛刀治疗的NSCLC脑转移瘤患者的临床资料,单纯SRS组49例,联合全脑放疗(WBRT)组27例。Kaplan-Meier法计算生存率及单因素分析、COX回归模型多因素分析。结果 SRS组中位生存期为6个月,联合WBRT组为7个月。单因素分析显示,病理、中枢外转移、原发灶控制、KPS评分、位置、RPA分级、GPA评分、SIR评分均与预后显著相关;用伽玛刀行单独SRS组与联合WBRT组在生存期上差异无显著性(χ2=0.077,P=0.781),其中RPA评级系统的Ⅰ、Ⅱ、Ⅲ级中位生存期分别为14、7、3个月(χ2=71.094,P=0.000);GPA评级系统的0~1、1.5~2.5、3、3.5~4分的中位生存期分别为2、5、12、20个月(χ2=40.988,P=0.000);SIR评级系统的1~3、4~7、8~10分的中位生存期分别为4、7、18个月(χ2=19.054,P=0.000)。多因素分析显示,KPS评分、中枢外转移、原发灶控制为预后独立因素(χ2=23.871,P=0.000;χ2=5.475,P=0.019;χ2=5.391,P=0.020)。单独对RPA、GPA、SIR系统进行COX分析,均呈显著相关(χ2=4.376,P=0.036;χ2=8.513,P=0.004;χ2=11.714,P=0.001)。纳入全部评级系统,COX分析仅示SIR评分呈显著相关(P=0.025)。结论 KPS评分、原发灶控制情况、中枢外转移是影响NSCLC脑转移瘤患者生存的独立因素,SIR评分更能对预后进行有效预测。Objective To evaluate the significance of different prognostic score indices for patients with brain metastases （BM） from non-small cell lung cancer after Gamma-knife （GK）. Methods 76 patients with BM after GK treatment were retrospectively analyzed. There were 49 patients treated by Stereotactic Radiosurgery （SRS）, 27 patients treated by SRS combined with Whole Brain Radiotherapy （SRS＋WBRT）. We used Kaplan-Meire method for univariate analyses, Cox regression model for multivariate analyses. Results Median overall survival of radiosurgery group and SRS＋ WBRT group were 6 months and 7 months, respectively. Univariate analysis showed that extracranial disease status, KPS score, histological type, site of lesions, Recursive partitioning analysis （RPA）, Graded Prognostic Assessment （GPA） and Score Index for Radiosurgery in Brain Metastases （SIR） were significantly correlated with prognosis. There was no difference of survival between SRS and SRS＋WBRT for non-small cell lung cancer patients with BM（χ^2=0. 077, p=0. 781）. Median survival of patients in the RPA classes I , lI and I]] was 14 months, 7 months and 3 months, respectively （χ^2= 71. 094, P= 0. 000）. Median survival of patients in GPA group from classes 0-1,1.5-2.5,3 and 3.5-4 were 2 months, 5 months, 12 months and 20 months, respectively（χ^2 = 40. 988, P=0. 000）. Median survival of patients in SIR group from 1- 3, 4- 7 and 8-10 was 4 months, 7 months and 18 months ,respectively（χ^2 = 19. 054,P=0. 000））. Multivariate analyses demonstrated that KPS score, primary tumor control and extracranial disease status were the independent prognostic factors （χ^2 = 23.871, P = 0. 000 ; χ^2 = 5. 475, P = 0.019 ; χ^2 = 5. 391, P = 0. 020）. Multivariate analysis also demonstrated significance difference for RPA/GPA and SIR, when tested individually（χ^2= 4. 376,P= 0. 036;χ^2 = 8. 513,P=0. 004;χ^2 11. 714,P=0. 001）. Applying the Cox Model to all of the three prognostic classifications, only SIR reached indep

关 键 词：非小细胞肺癌 脑转移瘤 伽玛刀/立体定向放射外科 生存/预后指标分析 

分 类 号：R734.2[医药卫生—肿瘤]