局部晚期非小细胞肺癌脑转移的危险因素及生存分析

Risk factors and survival analysis of locally advanced non-small cell lung cancer with brain metastasis

目的探讨局部晚期非小细胞肺癌（NSCLC）脑转移的危险因素及患者生存情况。方法根据随访期间是否发生脑转移,将124例ⅡA~Ⅳ期NSCLC患者分为脑转移组51例和非脑转移组73例,回顾性分析其临床资料,筛选发生脑转移的高危因素,并对比2组生存情况。结果 2组肺内转移情况、组织学分型、表皮生长因子受体（EGFR）基因型、除脑部以外的远处转移情况、淋巴结转移情况、血清乳酸脱氢酶（LDH）水平及癌胚抗原（CEA）水平差异有统计学意义（P〈0.05或〈0.01）,其中组织学分型、EGFR基因型、纵膈淋巴结转移及血清CEA水平为脑转移的独立影响因素（P〈0.05或〈0.01）。至随访结束,脑转移组中位生存时间19.60个月,非脑转移组中位生存时间33.40个月,差异有统计学意义（P〈0.01）。结论组织学分型、EGFR基因型、纵膈淋巴结转移及血清CEA水平是局部晚期NSCLC发生脑转移的独立影响因素,发生脑转移的患者生存预后较差。

Objective To explore the potential risk factors and survival situation of locally advanced non-small cell lung cancer（ NSCLC） patients with brain metastasis. Methods A total of stage IIA ~ IV NSCLC 124 patients were assigned into metastasis group（ n = 51） and non-metastasis group（ n = 73）. Their clinical data were retrospectively analyzed for potential risk factors of brain metastasis. Patients were followed-up for survival analysis. Results There were significant differences in lung metastasis rate,histological classification,type of epidermal growth factor receptor（ EGFR）,distant metastasis excluding brain,lymphatic metastasis,serum lactate dehydrogenase（ LDH） and carcinoembryonic antigen（ CEA） levels between two groups（ P〈0. 05,P〈0. 01）. The results of multifactor regression analysis showed histological classification,EGFR gene type,lymphatic metastasis and serum CEA level were independent factors of brain metastasis（ P〈0. 05,P〈0. 01）. The median survival time in metastasis group was 19. 60 months and was 33. 40 months in non-metastasis group,with a significant difference（ P〈0. 01）. Conclusion Histological classification,EGFR gene type,lymphatic metastasis and serum CEA level are independent factors of brain metastasis in NSCLC patients,which is collected with poor survival outcomes.