单中心肺腺癌脑膜转移的预后影响因素分析

Influencing factors for prognoses of pulmonary adenocarcinoma patients with leptomeningeal metastases:a single-center study

目的分析单中心肺腺癌脑膜转移患者的预后并探讨其影响因素。方法回顾性分析河南省人民医院神经内科自2010年1月至2021年6月诊治的肺腺癌脑膜转移患者资料,以总生存期(OS)作为预后评价标准将患者分为预后良好组(OS≥6个月)及预后不良组(OS<6个月)。比较2组患者一般资料并采用Logistic回归分析明确影响肺腺癌脑膜转移患者预后的独立因素。将患者按照Karnofsky功能状态(KPS)评分及不同治疗方案分组后绘制生存曲线并比较其总体生存率。结果研究共纳入173例患者,其中预后良好组75例,预后不良组87例。2组患者在KPS评分、肺腺癌原发病灶控制与否、是否应用第3代酪氨酸激酶抑制剂(TKI)治疗、是否采取全身化疗和全脑放疗方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示KPS评分和肺腺癌原发病灶控制与否是影响肺腺癌脑膜转移患者预后的独立因素(OR=4.186,95%CI:1.583~11.070,P=0.004;OR=4.198,95%CI:1.499~11.760,P=0.006)。生存曲线显示所有患者中位OS为8.2个月(95%CI:6.5~9.8)。低风险组(KPS≥60分)患者总体生存率显著高于高风险组(KPS<60分),应用第3代TKI治疗组患者总体生存率显著高于未应用第3代TKI治疗组,TKI联合全身化疗组患者总体生存率显著高于单独TKI治疗组,差异均有统计学意义(P<0.05)。结论KPS高评分及肺腺癌原发病灶控制好的肺腺癌脑膜转移患者预后相对较好,应用第3代TKI治疗及联合治疗可提高患者整体生存率。

Objective To investigate the prognoses of pulmonary adenocarcinoma patients with leptomeningeal metastases(LM)and explore their influencing factors.Methods A retrospective analysis was performed.The clinical data,imaging features and treatment plans of pulmonary adenocarcinoma patients with LM admitted to our hospital from January 2010 to June 2021 were collected.Overall survival(OS)was used as the prognostic evaluation criterion and patients were divided into good prognosis group(OS≥6 months)and poor prognosis group(OS<6 months)accordingly.Logistic regression analysis was used to evaluate the influencing factors for prognoses of pulmonary adenocarcinoma patients with LM.These patients were grouped according to different Karnofsky performance status(KPS)scores and different treatment methods,and survival curves were drawn to compare their OS.Results A total of 173 pulmonary adenocarcinoma patients with LM were enrolled in the study,including 75 with good prognosis and 87 with poor prognosis.There were significant differences in the KPS scores,pulmonary adenocarcinoma lesion controlled status,giving third generation tyrosine kinase inhibitor(TKI)therapy or not,giving systemic chemotherapy and/or whole brain radiotherapy or not between the two groups(P<0.05).Multivariate Logistic regression analysis showed that KPS scores and pulmonary adenocarcinoma lesion controlled status were independent influencing factors for prognoses(OR=4.186,95%CI:1.583-11.070,P=0.004;OR=4.198,95%CI:1.499-11.760,P=0.006).Survival curves showed median OS of 8.2 months for all patients(95%CI:6.5-9.8).The OS in patients with low-risk(KPS scores≥60)was significantly higher than that in patients with high-risk(KPS scores<60),that in patients accepted TKI treatment was significantly higher than that in patients not accepted TKI treatment,and that in patients accepted TKI and systemic chemotherapy was significantly higher than that in patients accepted TKI alone(P<0.05).Conclusion Patients with high KPS scores and controlled pulmonary adenocarcinoma can have relatively good prognosis;TKI treatment and combination therapy may prolong OS of these patients.