不同预后评分下非小细胞肺癌脑转移患者补量放疗的预后分析  

Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with supplemental radiotherapy under different prognostic scores

作　　者：申东星 刘志坤[1] 李振生[1] 韩慧娜 尚宇光 朱龙玉 孔德友[1] 张安度[1] 孔洁[1] 张舰[1] 杨芳[1] 曲福印 张钧[1] Shen Dongxing;Liu Zhikun;Li Zhensheng;Han Huina;Shang Yuguang;Zhu Longyu;Kong Deyou;Zhang Andu;Kong Jie;Zhang Jian;Yang Fang;Qu Fuyin;Zhang Jun(Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050035,China)

机构地区：[1]河北医科大学第四医院东院放疗科,石家庄050035

出　　处：《中华放射肿瘤学杂志》2022年第2期131-137,共7页Chinese Journal of Radiation Oncology

摘　　要：目的分析非小细胞肺癌(NSCLC)脑转移患者不同放疗模式的预后及影响因素,探讨不同预后评分下补量放疗的最佳获益人群。方法回顾性分析2013—2015年于河北医科大学第四医院诊治的NSCLC脑转移患者634例。按照不同放疗模式分为无放疗组330例、单纯全脑放疗(WBRT)组127例、全脑放疗+局部补量(WBRT+Boost)组177例。Kaplan-Meier法计算iPFS、OS,Cox模型多因素预后分析。结果所有患者中位iPFS期为6.9个月,中位OS期为9.0个月。无放疗、WBRT、WBRT+Boost组1年iPFS率分别为15.1%、16.3%、40.2%(P=0.002),1年OS分别为33.7%、38.2%、48.1%(P<0.001)。多因素分析显示不同放疗模式是影响iPFS和OS的独立因素。脑转移数目1~3个患者GPA评分2.5~4.0分时WBRT+Boost组1年OS、iPFS均优于WBRT组(P=0.026、0.044),无靶向治疗时WBRT+Boost组1年OS、iPFS均优于WBRT组(P=0.036、0.049);脑转移数目≥4个患者GPA评分2.5~4.0分、无靶向治疗时WBRT+Boost组1年iPFS优于WBRT组(P=0.019、0.012),GPA评分0~2分、有靶向治疗时WBRT+Boost组1年OS、iPFS似乎优于WBRT组(均P>0.05)。结论放疗能显著改善NSCLC脑转移患者的iPFS和OS,Boost可能进一步改善其预后。脑转移数目1~3个患者GPA评分2.5~4.0分、无靶向治疗时Boost可能提高iPFS和OS;脑转移数目≥4个患者GPA评分2.5~4.0分、无靶向治疗时Boost可能仅带来iPFS获益;GPA评分0~2分、有靶向治疗时Boost可能获益不明显。Objective To analyze the prognosis and influencing factors of different radiotherapy modes in patients with brain metastases from non-small cell lung cancer(NSCLC),and to explore the best benefit population with radiotherapy boost under different prognostic scores.Methods 634 patients with brain metastasis from NSCLC admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively.According to different radiotherapy modes,they were divided into three groups:no radiotherapy group(n=330),whole-brain radiotherapy group(WBRT)(n=127)and whole-brain radiotherapy combined with boost group(WBRT+boost)(n=177).The intracranial progression-free survival(iPFS)and overall survival(OS)were calculated by Kaplan-Meier method.The multivariate prognostic factors were analyzed by the Cox models.Results The median iPFS and OS of all patients were 6.9 months and 9.0 months,respectively.In the no radiotherapy,WBRT and WBRT+boost groups,the 1-year iPFS was 15.1%,16.3% and 40.2%(P=0.002),and the 1-year OS was 33.7%,38.2% and 48.1%(P<0.001),respectively.Multivariate survival analysis demonstrated that different radiotherapy modes were the independent factors affecting iPFS and OS.Subgroup analysis revealed that for patients with 1-3 brain metastases,the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone(P=0.026,P=0.044)when GPA score was 2.5-4.0;the 1-year OS and iPFSin the WBRT+boost group were better than those of WBRT alone(P=0.036,P=0.049)when there was no targeted therapy;for patients with≥4 brain metastases,the 1-year iPFS in the WBRT+boost group was better than that of WBRT alone(P=0.019,P=0.012)when GPA score was 2.5-4.0 and there was no targeted therapy.When the GPA score was 0-2 or there was targeted therapy,the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone,but the difference was not statistically significant(all P>0.05).Conclusions Radiotherapy can significantly improve the iPFS and OS of NSCLC patients with brain metast

关 键 词：脑转移 非小细胞肺癌/全脑放射疗法 全脑放射疗法 局部补量 预后 

分 类 号：R734.2[医药卫生—肿瘤]