352例肺癌脑转移患者治疗及预后分析

Analysis of treatment and prognosis of 352 lung cancer patients with brain metastases

目的分析针对肺癌脑转移的治疗方法与患者预后的关系。方法回顾性分析352例肺癌脑转移患者的临床资料。根据治疗方法的不同分为对症治疗组28例、单纯放疗或单纯化疗组(单纯放化疗组)49例和综合治疗组275例。综合治疗组又分为放疗联合化疗组(n=192)、立体定向放射治疗(γ刀)联合化疗或放化疗组(n=72)(联合化疗16例,联合放化疗56例)和手术联合化疗或放化疗组(n=11);其中111例化疗≤3周期,164例化疗≥4周期。描绘各组生存曲线,比较生存期和生存率。结果对症治疗组、单纯放化疗组、放疗联合化疗组、γ刀联合化疗或放化疗组和手术联合化疗或放化疗组患者的中位生存期分别为1.7、3.2、9.0、11.6、17.1个月。生存率分析显示,放疗联合化疗组优于单纯放化疗组(P=0.0000);γ刀联合化疗或放化疗组优于单纯放化疗组(P=0.0000);手术联合化疗或放化疗组优于单纯放化疗组和放疗联合化疗组(P=0.0001,P=0.0229),但与γ刀联合化疗或放化疗组比较差异无统计学意义(P=0.2543);γ刀联合放化疗与γ刀联合化疗患者的生存率比较差异无统计学意义(P=0.3804);综合治疗组中,化疗≥4周期患者的生存率明显高于化疗≤3周期的患者,差异有统计学意义(P=0.0000)。结论放疗联合化疗或γ刀联合放化疗是肺癌脑转移患者合适的治疗方法,后者的生存获益有好于前者的趋势;γ刀联合放疗与否对患者的生存期无明显影响;化疗以不少于4个周期为宜。

Objective To analyze the treatment and prognosis of lung cancer patients with brain metastases. Methods The clinical data of 352 lung cancer patients with brain metastases were retrospectively reviewed. According to the treatment modalities, patients were divided into palliative therapy group （n = 28）, simple whole brain radiotherapy （WBRT） or chemotherapy group （ n = 49） and comprehensive treatment group （ n = 275 ）. Comprehensive treatment group was subdivided into WBRT plus chemotherapy group（ n = 192 ） , stereotaetie radiosurgery （γ knife） plus chemotherapy/WBRT group （ n = 72, n = 16 for 3, knife plus chemotherapy and n = 56 for γ knife plus WBRT and chemotherapy） and neurosurgical resection plus chemotherapy/WBRT group（n = 11 ）. In comprehensive treatment group, 111 patients received chemotherapy ≤ 3 cycles, and the other 164 ≥4 cycles. Survival curves of each group were drawn respectively, and both survival time and survival rates were compared among groups. Results The median survival time of palliative therapy group, simple WBRT or chemotherapy group, WBRT plus chemotherapy group, γ knife plus chemotherapy/WBRT group and neurosurgical resection plus chemotherapy/WBRT group was 1. 7, 3.2, 9.0, 11.6 and 17.1 months, respectively. It was revealed by survival analysis that WBRT plus chemotherapy group was better than simple WBRT or chemotherapy group （P = 0. 0000） , γ knife plus chemotherapy/WBRT group was better than simple WBRT or chemotherapy group （ P = 0. 0000） , and neurosurgical resection plus chemotherapy/WBRT group was better than simple WBRT or chemotherapy group and WBRT plus chemotherapy group （ P = 0. 0001, P = 0. 0229）. There was no significant difference in survival rates between neurosurgical resection plus chemotherapy/WBRT group and γ knife plus ehemotherapy/WBRT group （P = 0. 2543） , and there was no significant difference in survival rates between those with γ knife plus chemotherapy and those with γ knife plus WBRT and chemotherapy （P = 0. 3804）. In comprehensive treatment group, the survival rates of those with chemotherapy ≥4 cycles was significantly higher than that of those with chemotherapy ≤ 3 cycles （P = 0. 0000）. Conclusion Both WBRT plus chemotherapy and 3, knife plus chemotherapy and WBRT are effective modalities for the treatment of lung cancer patients with brain metastases, and the latter has the tendency to gain more survival benefit. There is no significant difference in the survival time between patients receiving 3＇ knife with WBRT and those without. It is proper for the patients to have no less than 4 cycles of chemotherapy.