局限期小细胞肺癌预防性脑照射后脑转移相关危险因素分析

Analysis of risk factors for brain metastasis in patients with limited stage small cell lung cancer after prophylactic cranial irradiation

目的:明确局限期小细胞肺癌患者行预防性脑照射(prophylactic cranial irradiation, PCI)后发生脑转移的危险因素,并对相关因素进行分析。以筛选出不能从PCI中获益的人群,为PCI的临床应用提供参考。方法:回顾性分析2011年08月至2019年12月在我院接受过PCI的167例局限期小细胞肺癌患者的病历资料。采用SPSS 26.0统计软件对病历资料进行统计分析。用Kaplan-Meier法计算脑转移发生率及总生存率,并用Log-rank法进行检验。采用Cox回归对影响脑转移及总生存的危险因素进行单因素及多因素分析。结果:局限期小细胞肺癌患者PCI后1、2、3年脑转移率分别为3.8%、12.7%、18.9%。单因素及多因素分析结果显示原发肿瘤为T_(4)期(P=0.004,HR=7.06,95%CI:1.86~26.82)是影响患者PCI后脑转移的危险因素,T_(2)期(P=0.008,HR=2.48,95%CI:1.26~4.89)、T_(3)期(P=0.003,HR=3.38,95%CI:1.49~7.47)、T_(4)期(P=0.001,HR=3.87,95%CI:1.79~8.35)是影响患者总生存的危险因素。结论:较高的T分期是局限期小细胞肺癌患者PCI后脑转移及总生存的独立危险因素。即使T_(4)期患者PCI后脑转移发生率高于其他期别,但仍能够从PCI中获益。

Objective:To analyse the risk factors for brain metastases in patients with limited stage small cell lung cancer(LS-SCLC)after prophylactic cranial irradiation(PCI),and to identify characteristics of patients who can benefit from PCI,providing a reference for the clinical application of PCI.Methods:We reviewed the medical records of 167 LS-SCLC patients who underwent PCI in our hospital from August 2011 to December 2019.Statistical analysis of the medical records was performed by the SPSS 26.0 statistical software.The Kaplan-Meier method and Log-rank test were used to evaluate the risk of developing brain metastases and patient overall survival.Univariate and multivariate Cox regression analysis were explored to estimate risk variables for brain metastases and overall survival.Results:The 1-,2-,and 3-year brain metastasis rates of LS-SCLC patients after PCI were 3.8%,12.7%and 18.9%,respectively.The results of univariate and multivariate analysis showed that the primary tumor extent(T_(4) stage)was the independent risk factor for brain metastasis after PCI(P=0.004,HR=7.06,95%CI:1.86~26.82).Tumor stage T_(2)(P=0.008,HR=2.48,95%CI:1.26~4.89),T_(3)(P=0.003,HR=3.38,95%CI:1.49~7.47)and T_(4)(P=0.001,HR=3.87,95%CI:1.79~8.35)were the risk factors for overall survival of patients after PCI.Conclusion:The higher T stage was an independent risk factor for brain mtastases and overall survival in patients with LS-SCLC after PCI.Even though the incidence of brain metastasis in stage T_(4) patients after PCI was higher than other stages,they were still able to benefit from PCI.