肺癌脑转移214例生存及预后分析

Prognosis and survival for 214 lung cancer patients with brain metastases

目的探讨各种因素对214例肺癌脑转移病例生存的影响，分析可能影响预后的因素。方法对1992年1月至2001年12月浙江省肿瘤医院收治的214例肺癌脑转移病例资料进行回顾性分析。共有35例（16．4％）颅内单发转移瘤接受手术切除，其中单纯手术10例，手术联合全脑放疗8例，手术联合化疗2例，手术联合全脑放疗和化疗15例，单纯全脑放疗10例，单纯化疗36例，全脑放疗联合化疗104例，支持治疗29例。生存期定义为从患者接受治疗开始至死亡或随访结束的时间。应用Kaplan·Meier方法计算1、3、5年生存率和中位生存期并描绘生存曲线，long—rank试验评价组间生存差异，Cox回归多因素分析影响肺癌脑转移预后的各种因子。结果214例肺癌脑转移病例的中位生存期为10个月（95％CI9．06—10．94），1、3、5年累积生存率分别为7．46％、1．14％和0。根据患者的年龄、性别、病理类型和原发肿瘤分期及颅外脏器转移数目分析患者生存率，显示各组生存差异无统计学意义。各治疗方式中位生存期以联合手术、放化疗的综合治疗方式生存期最长（17个月），而手术联合化疗组和支持治疗组分别为3个月和4个月（P=0．00）。Cox回归多因素分析表明治疗方式是惟一的独立预后因素。结论对肺癌脑转移病例的积极治疗是有益的，其中联合手术治疗和全脑放疗、化疗等手段的综合治疗是最有效的。患者的年龄、性别、TNM分期和病理类型等因素和预后无明显相关。

Objective To determine long-term survival of 214 patients of lung cancer with brain metastases and to detect the potential prognostic factors. Methods A retrospective review was performed evaluating patients diagnosed as lung cancer with brain metastasis from Jan 1992 to Dec 2001 at Zhejiang Cancer Hospital. Two hundred and fourteen cases were enrolled. All hospital records were thoroughly reviewed in a retrospective manner. The management of the brain metastases were as follows： 8 patients underwent surgical resection and postoperative whole brain radiotherapy （WBRT）; 2 cases received resection and chemotherapy; 10 had resection alone; 10 underwent WBRT alone, 36 had chemotherapy alone; 15 received the combination of resection, chemotherapy and WBRT; 104 were performed with chemotherapy combined with WBRT; 29 had only supportive care. Survival time was measured from the date of the first treatment for malignancy to the date of death or the last follow-up. Seven further potential prognostic factors were investigated for survival including age, gender, T or N status, number of extra cranial metastases, pathological type and treatment modality. Statistical analysis was performed using the Kaplan- Meier method and Cox-regression analysis. Results The overall median survival time was 10 months （95% CI 9. 06-10.94） and the 1, 3, 5 year survival rates were 7. 46% , 1.14% and 0, respectively. In the univariate model, none of the following variables had effect on survival： age, gender, T stage of the tumor, nodal status, number of extra cranial metastases and histological type. Univariate analysis showed a better survival for the combination of surgical resection, chemotherapy and radiation （P = 0. 00）. Based on Cox-regression analysis, treatment modality was the only independent predictor of survival. Conclusions Aggressive combined therapy of brain metastases may achieve a survival advantage. Excellent overall survival of lung cancer with brain metastases has been achieved with a combination of WBRT with surgical resection and chemotherapy.