肺癌脑转移400例临床分析

Lung Cancer with Brain Metastases: Analysis of 400 Cases

背景和目的:肺癌脑转移发生频率较高。本文总结肺癌脑转移的临床特点及不同治疗方式对预后的影响。方法:回顾分析1995年1月～2000年12月本院400例肺癌脑转移的临床资料。结果:肺腺癌的脑转移发生率:腺癌41.3%,小细胞癌23.5%,鳞癌21.8%,鳞腺癌7.8%,未定型5%,肺泡癌0.8%。单发脑转移主要表现为头痛,呕吐,运动感觉障碍及意识障碍。肺部原发灶未治疗组平均3.1个月出现脑转移,治疗组平均7.4个月出现脑转移。脑转移灶手术切除或γ-刀治疗辅以化疗/放疗的中位生存期及1年、2年生存率分别为11.1月,30.7%和15.2%,10.9月,31.6%和10.6%。结论:肺腺癌最易发生脑转移,肺部原发灶的治疗可以延缓脑转移的出现,部分病人采用脑转移灶手术或脑γ-刀辅以化疗/放疗效果较好。

BACKGROUND & OBJECTIVE: Brain metastases are very common in patients with lung cancer. This paper is to summarize the clinical characteristics of the lung cancer patients with brain metastases and clinical outcome following different modalities of treatment. METHODS: Clinical materials were analyzed retrospectively in 400 lung cancer patients with brain metastases who were treated in our hospital from January 1995 to December 2000. RESULTS: The most common brain metastases from lung cancer was adenocarcinoma (41.3%). One hundred and twenty-one(30. 2% ) cases were solitary brain metastasis; 279(69. 8% )cases had multiple brain metastases. Headache, vomiting, motor deficit and alteration of consciousness were the common presenting symptoms. The average time from diagnosis of primary tumor to brain metastases was 3. 1 months and 7. 4 months in the patients whose primary lung cancers were untreated and treated, respectively. The median survival time and 1, 2 year survival rate in patients who received surgical resection of brain metastatic tumors were 11. 1 months,30. 7% and 15. 2%, respectively. The corresponding figure in patient treated with radiosurgery treatment plus radiation/chemotherapy were 10.9 months, 31.6% and 10.6% respectively. CONCLUSION: Adenocarcinoma is the most common metastatic tumor from lung cancer. Active treatment of the primary lung cancer may delay brain metastasis. The resection of brain metastases or radiosurgery treatment plus radiation/chemotherapy could prolong survival time of these patients.