ⅢA期非小细胞肺癌患者术后脑转移高危临床因素分析

Clinical Predictive Factors for Brain Metastasis from Stage ⅢA Non-Small-Cell Lung Cancer after Surgery

目的:本文探讨完整切除ⅢA期非小细胞肺癌(Non-small-cell lung cancer,NSCLC)术后高危脑转移的临床特征,分析ⅢA期NSCLC患者行预防性脑放射的指征。方法:对193例完整切除术后的ⅢA期NSCLC患者进行回顾性分析,观察术后是否出现脑转移对生存的影响,并分析患者的临床资料,找出ⅢA期NSCLC术后脑转移的高危临床因素。结果:全组患者的中位生存期为829(16～3092)天,累计1、2、3、4、5年生存率分别为80.3%、54.8%、37.6%、29.7%和21.9%。整个病程出现脑转移的患者有67例(34.7%),第1、2、3年脑转移发生率分别为15.0%、31.5%、40.1%。终生有脑转移患者的总生存和无复发生存均明显差于终生无脑转移的患者(P=0.011和P=0.0004),两者的中位生存期分别为700天和928天,终身是否出现脑转移是影响预后的重要独立因素(P=0.04,HR=1.546,95%CI:1.020～2.343)。Cox预后多因素回归分析发现影响脑转移的因素为术前血清学CEA水平(P=0.014,HR=2.152,95%CI:1.169～3.963),是否鳞癌(P=0.021,HR=0.400,95%CI:0.184～0.873)。结论:终身是否出现脑转移是影响预后的重要独立因素,ⅢA期术后脑转移高危因素为术前血清学CEA升高和病理类型为非鳞癌。

Objective： To evaluate clinical risk factors which can predict brain metastases after complete resection of stage ⅢA NSCLC and to determine the parameters that indicate Prophylactic Cranial Irradiation （PCI）. Methods： This study analyzed 193 patients with completely resected stage ⅢA NSCLC by evaluating the effect of brain metastases on survival. This study also sought to determine the clinical risk factors for brain metastasis. Results： Participants＇ median survival time was 829 days. The 1-, 2-, 3-, 4-, and 5-year overall survival rates were 80.3%, 54.8%, 37.6%, 29.7%, and 21.9%, respectively. Of the 193 patients, 34.7% （67/193） developed brain metastases at some point after resection. The incidence of brain metastases within 1, 2, and 3 years after surgery was 15.0%, 31.5%, and 40.1%, respectively. Univariate and multi- variate analyses identified pre-operative serum CEA elevation （P=-0.014, HR=2.152, 95% CI： 1.169-3.963） and squamous cell carcinoma （P=0.021, HR=0.400, 95% CI： 0.184-0.873） as independent clinical risk factors for brain metastasis. Conclusion： Pre-operative serum CEA elevation and squamous cell carcinoma were found to be independent clinical risk factors for NSCLC metastasis to the brain.