伽玛刀治疗肺癌脑转移瘤的疗效及影响生存时间和预后的相关因素分析

The curative effect, survival time and prognostic analysis for brain metastasis from lung cancer after Gamma-knife treatment

目的探讨伽玛刀治疗肺癌脑转移瘤方面的疗效及分析与其生存时间和预后相关的因素。方法选取106例于2013年1月至2015年1月期间在本院行伽玛刀治疗的肺癌脑转移瘤患者,按照其手术方式进行分组,其中42例行立体定向放射外科(SRS)治疗,30例行立体定向放射治疗(SRT)治疗,17例行SRS联合全脑放疗(WBRT)治疗,13例行SRS/SRT挽救治疗,4例行SRS联合WBRT挽救治疗,观察患者的疗效并分析影响其生存时间和预后的相关因素。结果 106例肺癌脑转移瘤患者经伽玛刀治疗后6个月生存率为50%,各种治疗方法治疗后的生存率和中位生存期分别为61%、57%、42%、30%、2%和9、8、6、5、3个月,差异有统计学意义(P<0.001);多因素Logistic回归分析的结果显示影响经伽玛刀治疗的肺癌脑转移瘤患者预后的相关因素主要有KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗(P<0.05)。结论肺癌脑转移瘤使用伽玛刀治疗可获得相似的生存率;影响患者术后生存时间和预后的因素主要是KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗。

Objective To explore the curative effect of Gamma-knife （GK） for patients with brain metastases（BM） from lung cancer and analyze the survival and prognostic factors of it. Method 106 patients with 710BM after GK of our hospital from January 2013 to January 2015 were chosen. Among them, there were 42 patients treated by SRS alone, 30 patients by SRT alone, 17 patients by SRS/SRT＋WBRT, 13 patients were salvaged by SRS/SRT, 4 patients salvaged by SRS/SRT＋WBRT. To observe the curative effect of the patients and analyze the survival and prognostic factors of of it. Results The 6 months survival rate for 106 patients with BM after GK was 50%, and the 6 months survival rate for SRS alone group, SRT alone group, SRS/SRT＋WBRT group, salvaged SRS/SRT group and salvaged SRS/SRT＋WBRT group were 61%, 57%, 42%, 30% and 2%. The median overall survival（MOS） were 9, 8, 6, 5, 3 months, the difference was statistically significant （P〈0.001）. Multivariate Logistic regression analysis showed that the survival and prognostic of patients with BM after GK were related with KPS score, the primary tumor control, histologicalal type and previous intrcranial treatment （P〈0.05）.Conclusion There is no difference of survival among SRS, SRT, SRS/SRT＋WBRT, salvaged SRS/SRT and salvaged SRS/SRT＋WBRT group for BM from lung cancer. The survival and prognostic factors of