550例局限期小细胞肺癌放化疗达缓解者预防性脑照射后脑转移风险评估  

Risk assessment of brain metastasis after prophylactic cranial irradiation for 550 limited stage small cell lung cancer patients with remission after radiochemotherapy

作　　者：陈梦圆 金佳男 季永领 胡晓[1] 陈明[1] Chen Mengyuan;Jin Jianan;Ji Yongling;Hu Xiao;Chen Ming(Department of Radiation Oncology,Institute of Basic Medicine and Cancer of Chinese Academy of Sciences,Cancer Hospital of University of Chinese Academy of Sciences,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]中国科学院基础医学与肿瘤研究所,中国科学院大学附属肿瘤医院,浙江省肿瘤医院放疗科,杭州310022

出　　处：《中华放射肿瘤学杂志》2022年第2期138-142,共5页Chinese Journal of Radiation Oncology

基　　金：浙江省卫生医药科技项目(2022KY618);国家卫生计生委科学研究基金-浙江省医药卫生重大科技计划(省部共建计划)项目(WKJ-ZJ-1701)。

摘　　要：目的评价影响放化疗后达完全缓解、部分缓解(CR/PR)的局限期小细胞肺癌(SCLC)患者预防性脑照射(PCI)后脑转移(BM)风险、预后因素。方法收集2002—2017年间在浙江省肿瘤医院治疗疗效达CR/PR且经PCI治疗的550例局限期SCLC患者的基本资料,回顾分析PCI后BM风险因素及预后。采用Kaplan-Meier法生存分析,Cox模型多因素预后分析。结果PCI后总体BM率为15.6%(86/550),Ⅰ、Ⅱ、Ⅲ期的分别为9%(4/43)、13%(7/52)、16.5%(75/455)。总体中位总生存(OS)期为27.9个月,5年OS率为31.0%;BM与未BM患者中位OS期分别为24.9个月与30.2个月,5年OS率分别为8.9%与36.1%(P<0.001)。BM是影响OS的因素(P<0.001);临床分期仍然是OS、无BM生存的影响因素(P<0.001、=0.027)。初治肿瘤最大直径≥5 cm者发生BM风险更高(P=0.034),但不影响OS(P=0.182)。年龄≥60岁与<60岁者中位OS期分别为24.6个月与34.9个月(P=0.001),2次/d与1次/d照射方式者中位OS期分别为29.8个月与24.5个月(P=0.013),年龄、性别、放疗分割、放化疗疗效(CR/PR)与BM发生率无关(均P>0.05)。结论初治肿瘤最大直径≥5 cm是放化疗后CR/PR的SCLC患者PCI后发生BM的高危因素,年龄<60岁者OS更好。Objective To evaluate the risk and prognostic factors of brain metastasis(BM)after prophylactic cranial irradiation(PCI)in limited stage small cell lung cancer(LS-SCLC)patients with complete and partial remission(CR/PR)after radiochemotherapy.Methods Baseline data of 550 patients with LS-SCLC who obtained CR/PR after chemoradiotherapy and received PCI in Zhejiang Cancer Hospital between 2002 and 2017 were collected.The risk of BM and clinical prognosis were retrospectively analyzed.The survival analysis was performed by Kaplan-Meier method.Multivariate prognostic analysis was conducted byCox models.Results The overall BM rate after PCI was 15.6%(86/550),with 9%(4/43),13%(7/52),and 16.5%(75/455)for stageⅠ,Ⅱ and Ⅲ patients,respectively.The median overall survival(OS)for the entire cohort was 27.9 months,and the 5-year OS rate was 31.0%.The OS was 24.9 and 30.2 months for patients with or without BM,and the 5-year OS rates were 8.9% and 36.1%(P<0.001).BM was an independent factor of OS(P<0.001).Clinical staging remained the influencing factor of OS and BM-free survival(P<0.001,P=0.027).Having tumors of≥5cm in diameter significantly increased the risk of BM(P=0.034)rather than the OS(P=0.182).The median OS of patients aged<60 years was significantly longer than those aged≥60 years(34.9 months vs.24.6 months,P=0.001).The median OS of patients irradiated with 2 times/d was 29.8 months,significantly longer than 24.5 months of those irradiated with 1 time/d(P=0.013).Age,sex,radiotherapy fraction and efficacy of radiochemotherapy(CR/PR)were not associated with the incidence rate of BM(all P>0.05).Conclusions SCLC patients with tumors of≥5cm in diameter may have a higher risk of developing BM after PCI.Patients aged<60 years achieve better OS compared with their counterparts aged≥60 years.

关 键 词：癌 小细胞肺/放化疗法 预防性脑照射 脑转移 预后 

分 类 号：R734.2[医药卫生—肿瘤]