荧光素钠辅助手术切除非小细胞肺癌脑转移瘤

Sodium fluorescein assisted surgical resection of brain metastases from non-small cell lung cancer

目的探讨荧光素钠(sodium fluorescein,SF)在非小细胞肺癌脑转移瘤手术中的应用价值。方法回顾性分析重庆大学附属肿瘤医院神经肿瘤科2020年1月至2021年12月接受手术治疗并经病理证实的非小细胞肺癌脑转移瘤患者的临床资料。根据是否在SF辅助下手术将患者分为SF辅助组和非SF辅助组,比较两组患者在肿瘤切除范围、局部复发率、术后生存时间等相关指标上的差异,并对其临床特点及预后因素进行综合分析。结果共纳入非小细胞肺癌脑转移患者45例,其中男31例,女14例,年龄26~77岁,中位年龄54岁。中位随访时间20个月(3~35个月),1年和2年生存率分别为88.9%(40/45)和33.3%(15/45)。SF辅助手术20例(44.4%),非SF辅助手术25例(55.6%)。SF组与非SF组在性别、年龄、术前卡诺夫斯基功能状态(Karnofsky performance status,KPS)评分、肿瘤位置(幕上或幕下)、颅内转移数量、有无颅外转移、术后综合治疗(化疗/靶向/免疫治疗)、术后头部放疗等方面均无统计学差异(P>0.05)。与非SF组相比,SF组肿瘤全切率更高(17/20 vs.14/25),局部复发率更低(2/20 vs.9/25)。多因素COX回归分析显示,手术方式(是否荧光素钠辅助)、手术切除范围及是否接受术后综合治疗是影响患者预后的危险因素(P<0.05)。结论荧光素钠辅助是安全可行的工具,有助于识别脑转移瘤与正常脑组织的边界,提高全切率,降低复发率,延长患者生存时间。

Objective To investigate the value of sodium fluorescein(SF)in the operation of brain metastases from non-small cell lung cancer(NSCLC).Methods Clinical data of patients with brain metastases from NSCLC confirmed by pathology who received surgical treatment from January 2020 to December 2021 in the Department of Neuro-Oncology,Chongqing University Cancer Hospital were retrospectively analyzed.Patients were divided into the SF-assisted group and the non-SF-assisted group according to whether they underwent SF-assisted surgery.The differences in the extent of tumor resection,local recurrence rate,postoperative survival time,and other related indicators between the two groups were compared,and their clinical characteristics and prognostic factors were comprehensively analyzed.Results A total of 45 patients with brain metastases from NSCLC were enrolled,including 31 males and 14 females,aged 26~77 years,with a median age of 54 years.The median follow-up time was 20 months(3~35 months).The 1-year and 2-year survival rates were 88.9%(40/45)and 33.3%(15/45)respectively.SF-assisted surgery was performed in 20 cases(44.4%)and non-SF-assisted surgery in 25 cases(55.6%).There were no statistical differences between the SF group and non-SF group in terms of gender,age,preoperative Karnofsky performance Status(KPS)score,tumor location(supratentorial or infratentorial),number of intracranial metastases,extracranial metastases or not,postoperative comprehensive treatment(chemo-/targeted/immunotherapy),and postoperative brain radiotherapy.Compared with the non-SF group,the SF group had a higher tumor resection rate(17/20 vs.14/25)and a lower local recurrence rate(2/20 vs.9/25).The univariate log-rank and multivariate COX regression analysis showed that the method of surgery(sodium fluorescein assisted),the extent of resection,and whether to receive postoperative comprehensive treatment were the risk factors affecting the prognosis of patients(P<0.05).Conclusion Sodium fluorescein is a safe and feasible tool,which is conducive to identifying the border between brain metastases and normal brain tissue,improving the total resection rate,reducing the recurrence rate,and prolonging the survival time of patients.