局部晚期非小细胞肺癌术后脑转移高危因素分析

Risk factor of brain metastasis in locally advanced non-small cell lung cancer after surgery

背景与目的脑转移已经成为局部晚期非小细胞肺癌(NSCLC)治疗失败的最主要因素之一。预防性脑放射是否用于NSCLC目前仍没有定论。本研究的目的是评估局部晚期NSCLC术后发生脑转移的高危因素,以便确定预防性脑放射的指征。方法回顾性分析223例在我院行外科手术的Ⅲ期NSCLC患者,分析其脑转移的高危因素,建立数学模型。结果全组病例中位生存期28个月,1、2、3年生存率分别为84.3%、56.9%、44.8%。全组病例脑转移发生率为38.1%(85/223)。多个区域纵隔淋巴结转移、多个纵隔淋巴结转移以及非鳞癌患者的脑转移发生率显著高于单区域纵隔淋巴结转移、纵隔淋巴结转移数目较少以及鳞癌患者(P=0.000,P=0.000,P=0.013)。脑转移的高危数学模型:logit(P)=8.215-0.903×纵隔淋巴结阳性数-0.872×手术性质-0.714×病理类型-1.893×纵隔淋巴结转移程度-0.948×病理分期-1.034×术后化疗。P≥0.44为脑转移高危人群。结论局部晚期NSCLC术后脑转移高危因素有:非鳞癌、纵隔多区域淋巴结转移、纵隔多个淋巴结转移。P≥0.44可能作为局部晚期NSCLC患者在临床研究中行预防性脑放射的参考指征。

Background and objective Brain metastasis has become one of the most important factors of the failure of treatment of locally advanced non-small cell lung cancer （LANSCLC）. There is no conclusion whether NSCLC patients should receive prophylactic cranial irradiation （PCI） or not. The aim of this study is to analyze the risk factors of brain metastasis of LANSCLC after surgery to find out the sign of PCI for LAN- SCLC. Methods A total of 223 patients with stage Ⅲ NSCLC who received surgical resection were retrospectively analyzed. The risk factors of brain metastasis were determined to set up a mathematic model for brain metastasis. Results The median survival time after surgery was 28. 0 months. The 1-, 2- and 3-year survival rate was 84.3%, 56.9% and 44.8% respectively. The incidence of brain metastasis was 38. 1% （85/223）. Patients with extensive mediastinal lymph node metastasis, more node metastasis and non-squamous carcinoma showed significantly higher incidence of brain metastasis than those with limited mediastinal lymph node metastasis, fewer positive mediastinal lymph nodes and squamous carcinoma （P=0. 000, P=0. 000, P=0. 013）. The mathematic model of brain metastasis was： logit（P） = 8. 215- 0. 903× NPN- 0. 872 × RT- 0. 714× HG -1. 893× LE- 0. 948 × HS- 1. 034× PC （ NPN = No. of positive nodes, RT = resection type, HG = histology, LE=location and extent of mediastinal lymph node metastasis, HS=histologic stage, PC= postoperative chemotherapy）. P≥0.44 meant high risk for brain metastasis. Conclusion High risk factors of brain metastasis in LANSCLC patients after complete resection of the cancer include non-squamous carcinoma, extensive and more mediastinal lymph node metastasis. P≥0.44 may be considered a sign of PCI in clinical trial.