局限期小细胞肺癌患者预防性脑照射后脑转移的关联分析:双中心研究  

Association analysis of brain metastases after prophylactic cranial irradiation in local disease small cell lung cancer: a bicenter study

作　　者：曾海燕[1,2] 李睿[3] 孙新东[2,4] 谢鹏[2,4] 孟雪[2,4] 范秉杰[2,4] 李万龙[2,4] 袁双虎[2,4] ZENG Haiyan LI Rui SUN Xindong XIE Peng MENG Xue FAN Bingjie LI Wanlong YUAN Shuanghu(School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250022, Shandong, China Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, China Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, Sichuan, China Shandong Academy of Medical Sciences, Jinan 250022, Shandong, China)

机构地区：[1]济南大学山东省医学科学院生命与科学学院,山东济南250022 [2]山东大学附属山东省肿瘤医院放疗科,山东济南250117 [3]四川省肿瘤医院放疗科,四川成都610041 [4]山东省医学科学院,山东济南250022

出　　处：《山东大学学报（医学版）》2017年第7期61-66,78,共7页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81372413;81502667);山东省自然科学基金(ZR2014HP041);山东省重点研发计划(2016GSF201167);公益性行业科研专项(201402011)

摘　　要：目的探讨局限期小细胞肺癌(LD-SCLC)患者进行预防性脑照射(PCI)后脑转移的高危因素,建立风险模型,指导临床进一步完善综合治疗策略。方法收集2003年7月至2014年6月接受PCI的LD-SCLC患者257例。采用Kaplan-Meier法计算无脑转移生存期和总生存期。Cox回归分析脑转移的影响因素并建立风险模型。结果中位随访时间34个月,47例(18.3%)出现脑转移。单因素分析显示,一般状态评分(PS)(P=0.040)及胸部放疗方式(P=0.001)与脑转移呈显著相关。多因素分析显示,PS>1分(P=0.017)、胸部加速超分割(P=0.004)、任何治疗开始时间至放疗结束时间(SER)较长(P=0.035)是脑转移独立危险因素,手术是脑转移独立保护因素(P=0.035)。总生存独立保护因素为手术、胸部放疗生物等效剂量(TRTBED)大于51.04 Gy;独立危险因素为年龄≥60岁、PS>1分、PCI高于标准剂量。结论一般状态较差、胸部加速超分割、SER较长增加LD-SCLC患者PCI后脑转移风险。高剂量的PCI不仅未降低脑转移,而且会缩短总生存期。Objective To explore the risk factors for brain metastases （BM） after prophylactic cranial irradiation （PCI） and to develop a hazard model to guide the clinical practice in local-disease small cell lung cancer （LD-SCLC）. Methods The clinical data of 257 LD-SCLC cases treated during July 2003 and June 2014 were retrieved. BM free survival （BMFS） and overall survival （OS） were estimated using Kaplan-Meier method. High risk factors and the hazard model for BM were identified using Cox regression analyses. Results During the median follow-up of 34 months, BM occurred in 47 （18.3%） patients. Univadate analyses indicated that performance status （PS） （P = 0. 040 ） and thoracic radiotherapy schedule （ P = 0. 001 ） were associated with BM. Multivariate analyses showed that PS 〉 1 （ P = 0.017 ） , thoracic hyperfractionated accelerated radiotherapy （HART） （ P = 0.004 ）, and long duration of ra- diotherapy （SER） （ P = 0. 035 ） were independent risk factors for BM, and surgery （ P = 0. 035 ） was the independent protective factor for BM. In addition, surgery and thoracic radiotherapy biological effective dose （BED） were inde- pendent protective factors for OS, while age≥60 yr, PS 〉 1 and PCI above standardized dosage were independent risk factors for OS. Conclusion Poor PS, thoracic HART and long SER are independent risk factors for BM after PCI in LD-SCLC. High dose of PCI does not prolong BMFS but shortens OS.

关 键 词：局限期小细胞肺癌 预防性脑照射 脑转移 高危因素 风险模型 

分 类 号：R734.2[医药卫生—肿瘤]