非小细胞肺癌脑转移预后影响因素

Prognostic factors of brain metastasis in non-small cell lung cancer

目的探讨非小细胞肺癌脑转移的生存情况及预后影响因素。方法选取我院2014年6月至2018年12月确诊139例非小细胞肺癌脑转移患者,收集临床资料并随访生存时间。运用Kaplan-Meier法对每个临床因素的不同水平进行生存分析,Log-rank法进行生存曲线的比较。采用单因素、多因素分析方法来筛选非小细胞肺癌脑转移的预后影响因素。结果本研究139例患者中位生存时间为11.2个月,对症支持组、全脑放疗组、靶向治疗组、全脑放疗+靶向治疗组、全脑放疗+化疗+靶向治疗组分别为8.1个月、10.1个月、14.6个月、16.7个月、23.4个月。单因素分析显示病理类型、发生脑转移的时间、EGFR突变的状态、RPA分级以及治疗方式对非小细胞肺癌脑转移的发生有显著影响作用。多因素分析表明KPS评分、RPA分级、治疗方法、发生脑转移的时间及EGFR突变状态是影响生存期的独立预后因素。结论经积极治疗(化疗+全脑放疗+靶向治疗)脑转移瘤患者可以获得更长生存期,高KPS评分、RPA I级、异时性脑转移及EGFR敏感突变型是非小细胞肺癌脑转移的预后良好因素。

Objective To evaluate the prognostic factors and overall survival state in patients with non-small cell lung cancer(NSCLC)and brain metastasis.Methods From June 2014 to December 2018,139 medical records of patients with brain metastasis,who received treatment in the Affiliated Hospital of Chengde Medical College,were analyzed.Their clinical data were collected and the survival time was followed up.It used Kaplan-Meier method to analyze each clinical factor,and log-rank method was used to compare survival curves.The significance of prognostic variables with regard to survival was determined by univariate and multivariate analyses.Results The median survival time of the 139 patients in this study was 11.2 months,and the median survival time of the symptomatic support group,the whole brain radiotherapy group,the targeted treatment group,the whole brain radiotherapy+targeted treatment,and the whole brain radiotherapy+chemotherapy+targeted treatment group were 8.1 months,10.1 months,14.6 months,16.7 months and 23.4 months,respectively.In univariate analysis,the significant prognostic factors associated with better survival included pathological type,the time of brain metastasis,the state of EGFR mutation,RPA grade and the treatment mode.In multivariate analysis,KPS score,RPA grade,treatment,time to brain metastasis,and EGFR mutation were the independent prognostic factors of survival.Conclusion Patients with brain metastases after active treatment(chemotherapy+whole brain radiotherapy+targeted therapy)can achieve longer survival,and high KPS score,RPA grade I,metachronous brain metastasis and EGFR sensitive mutations are good prognostic factors for brain metastasis of non-small cell lung cancer.