非小细胞肺癌合并脑转移62例外科手术治疗分析

Surgical treatment and prognostic analysis of non-small-cell lung cancer with brain metastasis

目的探讨手术改善非小细胞肺癌(NSCLC)合并脑转移患者的预后。方法对我院2005年3月—2013年5月切除NSCLC原发灶的62例患者进行分析,分析原发病灶的部位、手术方法、病理分型,脑转移灶的数量、治疗方式、治疗后的生存期等。结果本组男21例,女41例。全肺切除4例,肺叶、肺段或肺部分切除58例。腺癌47例(75.8%),鳞癌8例,混合型腺鳞癌7例。在处理脑转移瘤后再切除原发灶38例,先处理原发灶者24例。本组中位生存期18.7个月。其中1年生存率为75.9%;2年生存率为38.9%;3年生存率为16.7%。与同期未手术对照组比较1年生存率无差异,2、3年生存率比较差异有统计学意义(P<0.01)。结论积极处理肺部原发灶,结合头部放疗及全身化疗或基因靶向等综合治疗可延长生存期,提高此类患者预后。

Objective To find a new multidisciplinary treatment mode for brain metastasis of non-small-cell lung cancer. Methods We reviewed the 62 patients admitted from March 2005 to June 2013 in our hospital. We analyzed the primary lesion location,treatment modes,pathological types,number of brain lesion,and survival period. Results The 62 patients（ 21 males,41 females） with brain metastasis underwent resection of primary lesion. Of them,4 underwent pneumonectomy,and 58 underwent lobectomy,segmentectomy ort wedge resection. There were 47 cases（ 75. 8%） of adenocarcinoma,8 cases of squamous cell carcinoma and 7 cases of mixed carcinoma. There were 38 cases that underwent re-resection of primary lesion after treatment of brain metastatic tumor,and 24 cases that underwent treatment in reversed sequence. The medial survival period was 18. 7 months. The1-,2- and 3-year survival rates of the patients were 75. 9%,38. 9% and 16. 7%. Conclusion Individualized and comprehensive treatment may prolong the survival of the patients of non-small-cell lung cancer with brain metastasis and improve their life quality.