288例非小细胞肺癌脑转移全脑放射治疗的预后因素分析

目的]分析影响接受全脑放射治疗的非小细胞肺癌脑转移患者的预后因素；对比评估RPA和GPA两种预后指数对临床及研究的指导意义。方法]回顾性分析2006年1月～2008年8月在我科接受全脑放射治疗的288例非小细胞肺癌脑转移患者的临床资料，以Kaplan—Meier法计算生存率．采用多因素Cox回归法分析影响生存预后的各种因素。根据RPA和GPA两种预后指数分别建立预后模型，并分析模型中各亚组生存曲线的差异，各亚组生存率差异的比较采用Log-Rank检验。结果]各组患者随访时间为1-33个月，其中接受全脑放射治疗后的中位生存期为8个月（95％CI：7．07～8．92个月）。多因素分析显示放射治疗前的KPS评分、原发肿瘤控制情况、年龄、脑转移灶数目、颅外转移情况、分子靶向药物治疗情况是影响生存率的独立预后因素。根据RPA和GPA指数建立的预后模型，各亚组生存曲线的差异均有统计学意义（P〈0．001）。结论]KPS评分、原发肿瘤控制情况、年龄、脑转移灶数目、颅外转移情况、分子靶向药物治疗情况是影响非小细胞肺癌脑转移全脑放射治疗生存率的独立预后因素．RPA和GPA两种预后指数模型均能较好地反映预后。

Analysis of Prognostic Factors in 288 Non-small Cell Lung Cancer Cases with Brain Metastasis after Whole-brain Radiotherapy

Purpose] To investigate the prognostic factors in 288 non-small cell lung cancer（NSCLC） cases with brain metastasis（BM） ＇after whole-brain radiotherapy（WBRT）, to compare the significance of two prognostic index models of the RPA and GPA to clinical and to research. Methods] From Jan 2006 to Aug 2008, the clinical date of 288 non-small cell lung cancer cases with BM after WBRT were retrospective analysis. Survival rate was estimated by Kaplan-Meier method. Multi-factor Cox regression method was used to analyze the impact of prognostic factors on survival. Based on two prognostic index models （RPA and GPA）, the prognosis models were established respectively. The differences of survival rate in sub-group were used log-rank test. Results] All patients were followed up for 1-33 months, the median survival time after WBRT was 8 months （95% CI：7.07 -8.92 months）. Multi-factor analysis showed that the pre-radiotherapy KPS score, control of primary tumor, age, number of brain metastases, extracranial metastasis, molecular targeted drug treatment were independent prognostic factors affected the survival rate. According to RPA and GPA prognosis models, the survival curve differences in every sub-group were statistically significant （P〈0.001）. Conclusion] KPS score, primary tumor control, age, number of brain metastases, extracranial metastasis, molecular targeted drug treatment are the independent prognostic factors impacting the survival rate of non-small cell lung cancer with brain metastasis after whole brain radiotherapy. Both RPA and GPA model prognostic indexes could better reflect the prognosis.