肺癌脑转移患者脑转移灶体积与患者预后的关系研究

Relationship between the volume of brain metastases and prognosis in patients with brain metastases from lung cancer

目的探讨非小细胞肺癌(NSCLC)脑转移患者脑转移灶体积与预后的关系。方法 2012年1月至2016年6月接受全脑放疗的64例NSCLC脑转移患者进行回顾性分析,根据放疗前脑转移灶体积,将患者划分为大体积组和小体积组,对比两组基本特征、放疗结束3个月时脑转移灶局部控制情况及总生存情况。采用Cox回归模型,评估患者预后的影响因素。结果小体积组(体积<7.4 cm^3)、大体积组(体积≥7.4 cm^3)各32例患者,两组患者总体缓解率、疾病控制率对比,差异均无统计学意义(P>0.05)。大体积组中位生存时间7.5个月,明显短于小体积组11.2个月,差异有统计学意义(P<0.05)。卡氏体能状态评分是总生存时间的独立保护因素,年龄、脑转移灶体积,是总生存时间的独立危险因素。结论对NSCLC脑转移接受全脑放疗的患者,放疗前脑转移灶体积虽然不影响肿瘤近期控制效果,但较大的肿瘤体积可能与较短的生存时间有关。

Objective To investigate the relationship between the volume of brain metastases and prognosis in patients with brain metastases from non-small cell lung cancer(NSCLC). Methods Totally 64 NSCLC patients with brain metastases received whole brain radiotherapy from January 2012 to June 2016 were retrospectively analyzed. According to the volume of brain metastases before radiotherapy, patients were divided into large volume group and small volume group. The basic characteristics, local control of brain metastases at 3 months after radiotherapy and overall survival were compared between the two groups. Cox regression model was used to evaluate the prognostic factors of patients. Results Small volume group(Volume < 7.4 cm^3) and large volume group(volume ≥ 7.4 cm^3) had 32 cases respectively. There was no significant difference in overall remission rate and disease control rate between 2 groups(P>0.05). The median survival time of large volume group was 7.5 months, which was significantly shorter than that of small volume group(11.2 months), and the difference was statistically significant(P<0.05). Karnofsky performance status score was an independent protective factor for total survival time, while age and volume of brain metastases were independent risk factors for total survival time. Conclusion For patients with NSCLC brain metastases receiving whole brain radiotherapy, although the volume of brain metastases before radiotherapy does not affect the short-term control effect of tumors, the larger volume of tumors may be related to the shorter survival time.