非小细胞肺癌脑转移的发生及预后多因素分析

Effects of Multiple Factors on Occurrence and Prognosis of Brain Metastases from Non-Small-Cell Lung Carcinoma

目的探讨并分析各种临床、病理因素对非小细胞肺癌(NSCLC)脑转移的发生及其预后的影响。方法回顾性分析464例NSCLC患者(非脑转移399例,脑转移65例)的临床资料。生存期定义为患者确诊的时间至死亡或随访结束的时间。应用Kaplan-Meier方法计算患者确诊为肺癌脑转移后的1、2、3年生存率和中位生存期并描绘生存曲线,采用Logistic回归分析肺癌脑转移发生的高危因素,采用Cox模型对肺癌脑转移患者的预后进行多因素分析,并进行Log-rank时序检验。结果 Logistic回归显示,TNM分期、治疗前CEA水平、有无其他远处转移和是否放疗为NSCLC脑转移发生的主要影响因素。Cox回归多因素分析表明,是否手术和颅内转移数是NSCLC脑转移患者的独立预后因素。结论 TNM分期较晚、治疗前CEA水平较高、存在其他远处转移和未经放疗的NSCLC患者发生脑转移的概率较高,单发脑转移的患者和经手术治疗的患者生存期较长。

Objective To investigate and analyze the effects of various clinicopathologic factors on the occurrence and prognosis of brain metastases from non-small-cell lung carcinoma （NSCLC）. Methods Clinical data of 399 NSCLC patients without brain metastases and 65 NSCLC patients with brain metastases were retrospectively analyzed. Survival time was defined as the time from diagnosis to death or end of follow-up. Kaplan-Meier method was used to calculate the 1-,2-,and 3-year survival rates and median survival time. Logistic regression and Cox model were used to analyze the risk factors and prognostic factors for brain metastases from NSCLC, re spectively. In addition, the comparison was performed using log-rank test. Results Logistic re gression analysis showed that TNM staging,CEA levels before treatment,distant metastases and radiotherapy were the major factors influencing brain metastases from NSCLC. Cox multivariate analysis showed that the operation and number of intracranial metastases were the independent prognostic factors for brain metastases from NSCLC. Conclusion Advanced TNM staging,high CEA levels before treatment, distant metastases, and treatment without radiotherapy were posi tively associated with the occurrence of brain metastases in NSCLC patients. However, patients with single brain metastasis and patients undergoing operation have longer survival time.