胸部放化疗后完全缓解的局限期小细胞肺癌脑转移风险北大核心CSCD

目的评价影响胸部放化疗后完全缓解的Ⅱ_(B)-Ⅲ_(B)期小细胞肺癌患者发生脑转移的临床因素。方法回顾性分析191例于2009年1月至2016年4月在浙江省肿瘤医院接受胸部放化疗达到完全缓解的Ⅱ_(B)-Ⅲ_(B)期小细胞肺癌患者。对脑转移预后相关的因素,如性别、年龄、胸部放疗剂量、放化疗模式、治疗前血清神经元特异性烯醇化酶(NSE)和乳酸脱氢酶(LDH)、是否行预防性全脑照射(PCI)、TMN分期、体力状态评分(PS)等进行分析。使用log-rank法进行单因素分析,使用COX回归法进行多因素分析,使用Kaplan–Meier法绘制生存曲线。结果单因素分析提示治疗前LDH≥240 IU、治疗前NSE≥17 ng/ml、未行PCI和脑转移风险正相关(P<0.05)。多因素分析提示脑转移风险只和治疗前LDH≥240 IU(HR=1.90,95%CI为1.07~3.37,P=0.029)、未行PCI(HR=2.08,95%CI为1.17~3.72),P=0.013)正相关。结论治疗前血清LDH水平可为预测胸部放化疗后达到完全缓解的Ⅱ_(B)-Ⅲ_(B)期小细胞肺癌患者的脑转移风险提供重要价值。

Risk analysis of brain metastases in limited-stage small cell lung cancer (LS-SCLC)achieving complete remission after thoracic radio-chemotherapy

Objective Small cell lung cancer (SCLC) is a highly malignant tumor with a high risk of brain metastasis (BMs). The purpose of this study was to evaluate the clinical factors affecting the occurrence of BMs in patients with stage IIB-IIIB SCLC who achieved complete remission (CR) after thoracic radio-chemotherapy. Methods Clinical data of 191 patients with stage IIB-IIIB SCLC who achieved CR after thoracic radio-chemotherapy in Zhejiang Cancer Hospital from January 2009 to April 2016 were retrospectively analyzed. Common clinical factors related to the risk of BMs, including gender, age, thoracic radiotherapy dose, combined mode of radiotherapy and chemotherapy, pretreatment serum NSE and LDH, whether PCI was performed, TMN stage and PS score, were analyzed using log-rank method for univariate analysis, COX regression method for multivariate analysis and Kaplan-Meier method to plot the survival curve. Results Univariate analysis showed that pretreatment LDH level≥240IU, pretreatment NSE ≥17 ng/ml and no PCI were positively correlated with the risk of BMs (all P<0.05). Multivariate analysis showed that the risk of BMs was only positively correlated with pretreatment LDH≥240IU HR: 1.90, 95%CI(1.07-3.37), P=0.029], and no PCI HR:2.08, 95%CI(1.17-3.72), P=0.013]. Conclusions Pretreatment serum LDH levels provide important value for predicting the risk of BMs in patients with stage IIB-IIIB SCLC who achieve CR after thoracic radio-chemotherapy.