非小细胞肺癌合并孤立脑转移灶的手术疗效观察

The Efficacy of Surgical Treatment for Non-small Cell Lung Cancer with Single Brain Metastasis

目的探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果,分析影响患者生存期的因素。方法回顾性分析2005年1月-2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料,其中男35例,女11例;年龄35～67岁,平均53.2岁;所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术,其中肺叶切除术42例,全肺切除术4例,术后全部患者行全脑放射治疗,部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验,分析影响生存率的因素。结果术后病理检查提示腺癌27例,鳞癌15例,大细胞癌2例,其他类型2例。患者1年生存率80%,2年生存率41%,3年生存率14%,中位生存期23个月,平均生存期(27.8±4.5)个月(乘积极限法)。对数秩检验结果提示N0与N1患者比N2患者生存率高(P=0.024),腺癌患者生存期比非腺癌患者生存期长(P=0.002)。结论外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果,腺癌患者及无纵隔淋巴结转移的患者生存期长。

Objective To investigate the efficacy of surgical treatment for non-small cell lung cancer with solitary brain metastasis and to analyze the factors affecting survival of the patients.Methods We retrospectively analyzed the clinical data of 46 patients with non-small cell lung cancer and single brain metastasis who underwent surgical treatment between January 2005 and May 2011.Among them,35 were males and 11 were females,with a mean age of 53.2 years old ranged from 35 to 67.All patients underwent primary lung cancer and brain metastasis resection of the tumor.Lobectomy was performed in 42 cases,and pneumonectomy in 4 cases.Whole brain radiotherapy was the post-operative choice treatment. Some patients underwent systemic chemotherapy for 3 to 6 cycles.We used the log-rank test to analyze the survival time of the follow-up patients,and the factors that affect the survival rate were also analyzed.Results Postoperative pathological examination indicated that there were 27 cases of adenocarcinoma,15 of squamous cell carcinoma,2 of large cell carcinoma, and 2 of other types.Survival analysis showed an value of 80% at year one,41% at year two and 14% at the 3rd year point. The median survival was 23 months,and the mean survival time was（27.8 ± 4.5） months（Kaplan-Meier method）.According to Log-rank test results,prognosis was definitively better in N0 and N1 patients compared with N2 patients（P=0.024）,and it was also better in adenocarcinoma patients than in patients with other types of carcinoma（P=0.002）.Conclusions The surgical treatment for non-small cell lung cancer with solitary brain metastases can obtain good therapeutic effect.Patients with adenocarcinoma,and those without mediastinal lymph node metastasis have a longer survival time.