小细胞肺癌术后脑转移影响因素及预后分析

Risk factors for brain metastasis in small-cell lung cancer after surgery

目的分析小细胞肺癌根治术后恼转移的影响因素，探讨术后脑预防照射意义。方法对本院2000--2009年收治的有完整i已录的88例行根治性手术治疗的小细胞肺癌患者资料行回顾性分析，Kaplan-Meier法生存分析，Logistic回归模型分析脑转移发牛的影响因素。结果随访率100％，随访满B年者37例。3例行脑预防照射患者均未发牛脑转移；85例未行脑预防照射者脑转移发生率为24％，其中Ⅰ、Ⅱ、Ⅲ期患者3年脑转移发生率分别为4％、26％、29％（χ2=7．57，P=0．023）。发生腑转移与木发生脑转移患者的中位生存时间分别为18个月和48个月，3年生仔率分别为25％和59％（χ2=10．63，P=0．001）。全组患者单因素及多因素回归分析均显示疗前分期是腑转移的影响因素（χ2=7．57、8．52，P=0．023、0．004），而年龄、性别、肿瘤部位、病理类型、术前化疗、术后放／化疗均不是脑转移的影响因素（χ2=0．03、0．00、0．00、2．58、0．01、1．23、0．84，P=0．869、0．998、0．992、0．109、0．936、0．266、0．361）。结论疗前分期足小细胞肺癌根治术后脯转移的影响因素。Ⅰ期小细胞肺癌腩转移率低、总生存期较长、术后行脑预防照射意义不大，Ⅱ、Ⅲ期患者脑转移率高、发生脑转移后预后差、建议行脑预防照射。

Objective To evaluate clinical risk factors that can predict brain metastasis after complete resection of small cell lung cancer （SCLC） and to assess the role of prophylactic cranial irradiation （PCI） in such kind of patients. Methods Eighty-eight patients with completely resec, ted stage Ⅰ-Ⅲ SCLC from Jan. 2000 to Dee. 2009 in our hospital were retrospectively analyzed. Kaplan-Meier was used to compare the differences in the incidence of metastasis free survival in diffrent groups. Logistic model was used to assess the independent risk factors for brain metastasis. Results The follow-up rate is 100% ,and 37 patients were followed up tor more than three years. None of the 3 patients who received PCI developed brain metastasis, while for patients without receiving PCI, 24% developed brain metastases. The incidence of brain metastasis for stage Ⅰ、Ⅱand Ⅲ SCLC after surgery were 4% , 26% and 29% （χ2 =7.57,P = 0. 023） , respectively. The median survival time and the 3-year survival rate were 18 months and 25% for patients who developed brain metastasis, and 48 months and 59% for those without brain metastasis （ χ2= 10. 63, P =0. 001 ）. Both univariate and muhivariate analyses showed that pre-treatment disease stage was independent risk factor for brain metastasis （ χ2 = 7.57,8.52; P = 0. 023,0. 004）. Age, sex, tumor location, pathological type, induction chemotherapy, and postoperative chemotherapy/radiotherapy were not significantly correlated with the incidence of brain metastasis （ χ2= 0. 03,0. 00,0. 00,2. 58,0.01,1.23, 0. 84;P = 0. 869,0. 998,0. 992,0. 109,0. 936,0. 266,0. 361, respectively）. Conclusions Pre-treatment disease stage was independent risk factor for brain metastasis in SCLC. PCI may be important for stage Ⅱ-Ⅲ SCLC but not for stage Ⅰ disease.