非小细胞肺癌脑转移出现脑膜转移的高危影响因素、治疗方式选择及相关生存时间研究

Study on high risk factors,treatment options and related survival time of meningeal metastasis in non-small cell lung cancer with brain metastasis

目的探讨非小细胞肺癌脑转移患者出现脑膜转移的高危影响因素、治疗方式选择策略及相关生存时间。方法通过回顾性分析方法,选择福建省肿瘤医院2014年1月至2024年1月收治的170例非小细胞肺癌脑转移患者,将其分为合并脑膜转移组(63例)及无合并脑膜转移组(107例),比较2组基本临床特征、分子病理特征、生存期、治疗方式;同时追踪、分析非小细胞肺癌脑转移合并脑膜转移患者的临床生存信息,分析非小细胞肺癌脑转移患者出现脑膜转移的相关病程进展时间及生存时间。结果121例表皮生长因子受体(EGFR)突变非小细胞肺癌脑转移患者中51例(42.15%)出现了脑膜转移,而在EGFR无突变非小细胞肺癌脑转移患者中只有24.49%(12/49)出现了脑膜转移(χ^(2)=4.663,P=0.031)。合并脑膜转移患者有49.20%(31/63)进行了鞘内注射化学治疗,与无合并脑膜转移组比较,差异有统计学意义(χ^(2)=64.393,P<0.001)。而在其他治疗方式,如手术、放射治疗、化学治疗、靶向、抗肿瘤血管生成及免疫治疗方式选择上,差异均无统计学意义(P>0.05)。63例合并脑膜转移非小细胞肺癌脑转移患者从发现肺癌到出现脑膜转移的中位时间为35个月,95%可信区间为27.230~42.770;从发现肺癌脑转移到出现脑膜转移的中位时间为12个月,95%可信区间为7.139~16.861。结论EGFR突变是非小细胞肺癌脑转移患者发生脑膜转移的高危因素。对非小细胞肺癌出现脑、脑膜转移患者,在综合治疗基础上加用鞘内注射化学治疗是一种有前景的治疗方式。

Objective To investigate the risk factors,treatment strategies and related survival time of meningeal metastasis in patients with non-small cell lung cancer with brain metastasis.Methods A total of 170 patients with brain metastasis of non-small cell lung cancer in Fujian Cancer Hospital were analyzed retrospectively.They were divided into the combined meningeal metastasis group and the non-combined meningeal metastasis group.The basic clinical characteristics,molecular pathological characteristics,survival time and treatment options were compared between the two groups.At the same time,the clinical survival information of 63 patients with brain metastasis and meningeal metastasis of non-small cell lung cancer was tracked and analyzed,and the progression time and survival time of meningeal metastasis in patients with brain metastasis of non-small cell lung cancer were analyzed.Results Among the 121 patients with epidermal growth factor(EGFR)mutation-positive non-small cell lung cancer and brain metastasis,51 patients(42.15%)had meningeal metastasis.While only 24.49%(12/49)of patients with brain metastases from non-small cell lung cancer without EGFR mutation had meningeal metastasis(χ^(2)=4.663,P=0.031).49.20%(31/63)of patients with meningeal metastasis received intrathecal chemotherapy,compared with no meningeal metastasis,the difference was statistically significant(χ^(2)=64.393,P<0.001).There was no significant difference in other treatment methods,such as surgery,radiotherapy,chemotherapy,targeting,anti-tumor angiogenesis and immunotherapy(P>0.05).The median time from the discovery of lung cancer to the occurrence of meningeal metastasis in 63 patients with non-small cell lung cancer with meningeal metastasis was 35 months,with a 95%confidence interval of 27.230-42.770.The median time from the discovery of brain metastases to the occurrence of meningeal metastases in 63 patients with brain metastases from non-small cell lung cancer with meningeal metastases was 12 months,with a 95%confidence interval of 7.139-16.861.Conclusion EGFR mutation is a high risk factor for meningeal metastasis in patients with non-small cell lung cancer brain metastasis.For patients with brain and meningeal metastasis of non-small cell lung cancer,intrathecal chemotherapy on the basis of comprehensive treatment is a promising treatment.