头部伽马刀治疗非小细胞肺癌脑转移的临床效果及预后情况分析

Clinical Effect and Prognosis of Head Gamma Knife in Patients with Non-small CLC

目的 探讨头部伽马刀治疗非小细胞肺癌(NSCLC)脑转移的临床效果及预后相关影响因素。方法 回顾性分析82例NSCLC脑转移患者临床资料。所有患者均行头部伽马刀治疗,术后评价近期疗效,并随访1年,依据患者存活情况分为存活组与死亡组,收集2组年龄、性别、体质量指数、病理类型、原发癌部位、卡氏功能状态(KPS)评分、肺癌分级预后评估系统(GPA)评分、颅外转移、脑转移数目、脑转移瘤最大直径、胸部手术等资料,先开展单因素分析,得到有差异的项目后再行Logistic回归分析,获取影响头部伽马刀治疗NSCLC脑转移预后的独立危险因素。结果 82例NSCLC脑转移患者治疗后完全缓解13例,部分缓解48例,稳定14例,进展7例,总控制率为91.46%(75/82)。随访1年,82例NSCLC脑转移患者共存活39例,存活率为47.56%(39/82);单因素分析显示,年龄、KPS评分、GPA评分、颅外转移、脑转移数目、脑转移瘤最大直径、脑转移位置与头部伽马刀治疗NSCLC脑转移的预后相关,差异有统计学意义(P<0.05);多因素分析显示,≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm为影响头部伽马刀治疗NSCLC脑转移预后的高危因素(P<0.05且OR>1)。结论 头部伽马刀治疗NSCLC脑转移可取得较为理想的近期疗效,但≥65岁、KPS评分<70分、GPA评分≤1.5分、有颅外转移、脑转移数目>3个、脑转移瘤最大直径>2 cm等的NSCLC脑转移患者预后欠佳,临床需针对性开展干预措施,提高整体生存率。

Objective To investigate the clinical effect and prognostic factors of head gamma knife in the treatment of brain metastases from non-small cell lung cancer(NSCLC).Methods Clinical data of 82 patients with brain metastasis of NSCLC were analyzed retrospectively.All patients were treated with head gamma knife.The short-term curative effect was evaluated after operation and followed up for 1 year.According to the survival of patients, they were divided into survival group and death group.The data of age, sex, body mass index, pathological type, location of primary cancer, Karnofsky functional status(KPS) score, lung cancer grading prognosis evaluation system(GPA) score, extracranial metastasis, number of brain metastases, maximum diameter of brain metastases, chest surgery and other data were collected, Univariate analysis was carried out first, and logistic regression analysis was carried out after obtaining different items to obtain independent risk factors affecting the prognosis of brain metastasis of NSCLC treated with head gamma knife.Results Among 82 patients with brain metastasis of NSCLC,13 cases were in complete remission, 48 cases were in partial remission, 14 cases were stable, and 7 cases were progressive.The total control rate was 91.46%(75/82);During a one-year follow-up, 39 of 82 patients with brain metastases from NSCLC survived, with a survival rate of 47.56%(39/82);Univariate analysis showed that age, KPS score, GPA score, extracranial metastasis, the number of brain metastases, the maximum diameter of brain metastases, and the location of brain metastases were significantly correlated with the prognosis of NSCLC brain metastases treated with head gamma knife(P<0.05);Multiple factors analysis showed that ≥65 years old, KPS score <70,GPA score ≤1.5,extracranial metastasis, number of brain metastases >3,and the maximum diameter of brain metastases >2 cm were high-risk factors affecting the prognosis of NSCLC brain metastases treated with head gamma knife(P<0.05 and or >1).Conclusion Head gamma knife treatment of NSCLC brain metastasis can achieve relatively ideal short-term efficacy, but NSCLC brain metastasis patients are vulnerable to ≥ 65 years old, KPS score <70 points, GPA score ≤1.5 points, extracranial metastasis, the number of brain metastases >3,the maximum diameter of brain metastases >2cm, and the prognosis is poor.Targeted clinical interventions are needed to improve the overall survival rate.