单纯脑转移与脑合并多器官转移小细胞肺癌患者的生存分析

Survival analysis of patients with brain-single metastasis and brain and organs-multiple metastasis small cell lung cancer

目的比较小细胞肺癌(SCLC)患者单纯脑转移与脑合并多器官转移的生存结局。方法使用美国监测、流行病学和最终结果数据库,选取2004—2015年具有完整临床信息的SCLC患者5520例,根据转移部位分析患者的倾向评分后对SCLC患者进行调整、分层或匹配,比较单纯脑转移组和脑合并多器官转移组患者的肿瘤特异生存率和总生存率;再比较放疗和化疗对两组肿瘤特异生存率的影响。结果5520例SCLC患者中,单纯脑转移组2658例,脑合并多器官转移组2862例。倾向评分分层或匹配后,单纯脑转移组与脑合并多器官转移组中位生存时间分别为6和4个月,两组比较差异有统计学意义(P<0.05)。单纯脑转移组病死率明显低于脑合并多器官转移组(80.66%比85.96%),差异有统计学意义(P<0.01)。Kaplan-Meier生存曲线分析结果显示,单纯脑转移组总生存率和肿瘤特异生存率均明显优于脑合并多器官转移组[14.72%比9.50%和19.34%比14.04%],差异有统计学意义(P<0.01)。Cox分析结果显示,年龄、种族、T分期、性别、N分期、放疗、化疗、肿瘤直径、婚姻和转移对SCLC脑转移患者肿瘤特异生存率有影响(P<0.01或<0.05)。多因素Logistic回归分析结果显示,放疗和化疗能明显改善患者的肿瘤特异生存率(HR=0.668和0.671,95%CI 0.570~0.783和0.573~0.786,P<0.01)。结论SCLC单纯脑转移患者的生存率高于SCLC脑合并多器官转移患者;化疗和放疗可改善SCLC脑转移患者的生存率。

Objective To compare the survival outcomes in patients of small cell lung cancer(SCLC)with brain-single metastasis and brain with organs-multiple metastasis.Methods Using the US surveillance,epidemiology and final results database,5520 SCLC patients with complete clinical information from 2004 to 2015 were selected.SCLC patients were adjusted,stratified or matched according to the metastasis site after the stratification or matching of the propensity scores,and the lung cancer-specific survival(CSS)rate and overall survival(OS)rate were compared between brain-single metastasis group and brain with organs-multiple metastasis group.In addition,the effects of chemotherapy and radiotherapy in CSS between brain-single metastasis group and brain with organs-multiple metastasis group were compared.Results Of the 5520 SCLC patients,2658 cases was in the brain-single metastasis group,and 2862 cases was in brain with organs-multiple metastasis group.After the stratification or matching of the propensity scores,the median survival time in brain-single metastasis group was significantly longer than that in brain with organs-multiple metastasis group(6 months vs.4 months),and there was statistical difference(P<0.05).The fatality rate in brain-single metastasis group was significantly lower than that in brain with organs-multiple metastasis group(80.66%vs.85.96%),and there was statistical difference(P<0.01).Kaplan-Meier survival curve analysis result showed that the OS rate and CSS rate in brain-single metastasis group were significantly higher than those in brain with organs-multiple metastasis group(14.72%vs.9.50%and 19.34%vs.14.04%),and there were statistical differences(P<0.05).Cox analysis result showed that age,race,T stage,gender,N stage,radiotherapy,chemotherapy,tumor diameter,marriage and metastasis were the influencing factors of CSS rate in SCLC patients with brain metastasis(P<0.01 or<0.05).Multivariate Logistic regression analysis result showed that radiotherapy and chemotherapy can significantly improve the CSS rate(HR=0.668 and 0.671,95%CI 0.570 to 0.783 and 0.573 to 0.786,P<0.01).Conclusions The survival rate in SCLC patients with brain-single metastasis is higher than that of SCLC patients with brain with organs-multiple metastasis;chemotherapy and radiotherapy can improve the survival rate in SCLC patients with brain metastasis.