基于SEER数据库的小细胞肺癌患者脑转移临床特征及预后分析

Clinical characteristics and prognosis of brain metastasis in patients with small cell lung cancer based on SEER database

目的基于SEER数据库分析小细胞肺癌(small cell lung cancer, SCLC)脑转移(brain metastases, BM)患者的临床特征及预后相关因素。方法使用美国监测、流行病学和结局数据库(SEER数据库),收集2010—2015年具有完整临床信息的SCLC患者的27 872例,根据2015年的随访结果将SCLC病例分为脑转移组和无脑转移组。通过单因素和COX多因素分析SCLC患者的性别、种族、年龄、肿瘤大小、好发部位、分化程度和诊断年份等临床特征与脑转移发生率的关联。根据Kaplan-Meier分析脑转移对SCLC患者肺癌特异性生存率(cancer-specific survival, CSS)和总生存率(overall survival, OS)的影响。此外,进一步分析手术、放射疗法和化学疗法对脑转移患者CSS和OS的影响。结果在72个月的随访期间,27 872例原发性SCLC中脑转移的发生率为17%。与20~39年龄组相比,≥80年龄组患者脑转移发生率低(HR=1.151,95%CI:1.157~1.297,P=0.02)。脑转移患者的中位生存期(6.5个月)低于无脑转移患者(9.8个月)(P<0.001)。男性SCLC患者脑转移发生率高(HR=0.883,95%CI:0.833~0.937,P<0.01)。相比未放疗组,放疗组SCLC患者脑转移发生率更低(HR=0.369,95%CI:0.346~0.394,P<0.01)。结论 SCLC患者脑转移的生存率低并且因年龄和性别而异。此外,放射疗法对脑转移患者的的生存率有益。

Objective To analyze the clinical characteristics and prognosis of patients with brain metastases(BM)from small cell lung cancer(SCLC)based on SEER database.Methods A total of 27872 SCLC patients with complete clinical information were collected from United States Surveillance,Epidemiology,and Final Results Registry(SEER database)between 2010 and 2015.According to the follow-up results in 2015,SCLC cases were divided into BM group and non-BM group.Univariate and multivariate COX analyses were used to analyze the relationship between the clinical characteristics of SCLC patients and the incidence of BM.Kaplan-Meier curve was used to determine the cancer-specific survival(CSS)and overall survival(OS)of patients;the effect of BM on CSS and OS was analyzed;in addition,the effects of surgery,radiation therapy and chemotherapy on CSS and OS of BM patients were further analyzed.Results During the 72-month follow-up,the incidence of BM in 27872 cases of primary SCLC was 17%.Compared with the 20-39 age group,the incidence of BM was lower in the≥80 age group(HR=1.151,95%CI:1.157-1.297,P=0.02).The median survival time of BM patients was lower than that of patients without BM(6.5 months vs 9.8 months,P<0.001).The incidence of BM in male SCLC patients was higher(HR=0.883,95%CI:0.833-0.937,P<0.01).In addition,compared with the non-radiotherapy group,the incidence of BM in the radiotherapy group was lower(HR=0.369,95%CI:0.346-0.394,P<0.01).Conclusion The survival rate of SCLC patients with BM is low and varies with age and gender.In addition,radiation therapy has a beneficial effect on the survival of BM patients.