以脑转移为首发的肺癌患者的临床特点及预后影响因素分析  

Analysis of Clinical Features and Prognostic Factors of Patients with Lung Cancer Primary Brain Metastases

作　　者：安云霞[1] 张群成 轩伟霞[1] 程相松 刘海洋 刘畅 张晓菊[1] AN Yunxia;ZHANG Quncheng;XUAN Weixia(Henan Province People＇s Hospital,Zhengzhou,45000)

机构地区：[1]河南省人民医院,450000

出　　处：《实用癌症杂志》2018年第5期801-804,共4页The Practical Journal of Cancer

基　　金：河南省科技厅基础与前沿项目(项目编号:142300410383)

摘　　要：目的分析以脑转移为首发的肺癌患者的临床特点,探究影响其预后效果的因素。方法选取以脑转移为首发的肺癌患者500例,通过分析患者临床特征,用Kaplan-Meier计算患者生存率、中位生存期、绘制患者累积生存函数曲线,用Log-rank对相关因素行单因素分析,用Cox回归模型对单因素分析后有统计学意义的因素进行多因素预后分析。结果 500例患者中有438例患者经过随访收集到完整资料,总随访率为87.6%,患者发病时最常见的神经系统症状为颅高压症状,病理类型主要以腺癌为主,占总患者的55.7%,肺癌脑转移部位主要以大脑幕上为主,占总患者的55.9%,438例患者中位随访时间为16个月,中位生存期为15个月,1年、2年、3年、4年、5年生存率分别为53.7%、32.6%、21.3%、13.9%、9.4%,单因素分析患者的年龄是否>60岁、发病急缓、病理类型是否为腺癌、病理类型是否为低分化癌,肺部原发病灶是否放疗,手术治疗是否联合SRS技术6个因素对患者生存率有影响,多因素分析显示患者的年龄是否>60岁、发病急缓、病理类型是否为腺癌,有无靶向治疗既往史4个因素是影响患者生存率的独立预后影响因素。结论脑转移首发表征肺癌患者颅高压症状颅内转移灶多发于大脑半球,患者年龄>60、发病急骤、非腺癌、未行靶向治疗其独立不良预后影响因素。Objective To analyze the clinical characteristics of lung cancer patients with brain metastases as the first episode,to explore the factors affecting their prognosis. Methods A total of 500 patients with lung cancer were selected. The survival rate and median survival time were calculated by Kaplan-Meier. The cumulative survival function curve was calculated by using Kaplan-Meier. The log-rank was used to analyze the correlation factors,Cox regression model was used to conduct the multivariate analysis for statistical factors after univariate analysis. Results Of the 500 patients,438 patients received complete data from follow-up. The total follow-up rate was 87. 6%. The most common neurological symptoms were the symptoms of cranial hypertension. The pathologic type was predominantly adenocarcinoma,accounting for 55. 7% of the total patients The median follow-up time of 438 patients was 16 months,the median survival time was 15 months,1-,2-,3-,4-,5-year survival rates were 53. 7%,32. 6%,21. 3%,13. 9%,9. 4%,single-factor analysis showde that patients older than 60,the incidence of acute illress,pathological type of adenocarcinoma,pathological type of the poorly differentiated carcinoma,whether the primary lesion of the lungs accepted radiotherapy,the combined treatment of SRS technique effect the survival rate of the patients. Multivariate analysis showed that whether the age of the patients was greater than 60,the incidence of acute onset and the pathological type of gland Cancer,and targeted therapy history were independent prognostic factors that affect the survival rate of patients. Conclusion Brain metastases in the first manifestation of lung cancer patients with intracranial hypertension symptoms of intracranial metastases is mainly in the cerebral hemisphere,patients older than 60,the incidence of acute onset,non-adenocarcinoma,non-targeted treatment are independent adverse prognostic factors.

关 键 词：脑转移为首发 肺癌 临床特点 预后影响因素 

分 类 号：R734.2[医药卫生—肿瘤]