不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及危险因素分析

目的 探讨不可手术的局部晚期非小细胞肺癌患者胸部放疗后脑转移特征及其危险因素.方法 选取经组织病理学检查或免疫组化检查证实的不可手术的局部晚期非小细胞肺癌患者72例.根据患者各项资料,分析不可手术的局部晚期非小细胞肺癌患者放疗后脑转移特征,使用多因素Logistic回归分析影响不可手术的局部晚期非小细胞肺癌患者放疗后脑转移的危险因素.结果 72例患者中,15例(20.83%)患者出现脑转移,其中腺癌14例,鳞癌1例;单纯脑转移2例,脑转移合并其他部位转移13例.患者出现脑转移的中位时间为8.5个月,1年、3年累积脑转移率分别为16.31%、29.94%.单因素分析结果显示:患者的年龄、吸烟史、CA125、NSE、CEA与局部晚期非小细胞肺癌患者胸部放疗后脑转移存在一定关系(P﹤0.05).多因素Logistic回归分析结果显示:年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌是影响局部晚期非小细胞肺癌患者胸部放疗后脑转移的危险因素.结论 年龄﹥60岁、有吸烟史、CA125升高、NSE升高、非鳞状细胞癌的局部晚期非小细胞肺癌患者胸部放疗后出现脑转移的危险性高.

Analysis of characteristics and risk factors of brain metastases following thoracic radiotherapy in surgery-ineligible patients with locally advanced non-small cell lung cancer

Objective To investigate the characteristics and risk factors of brain metastases following thoracic radio-therapy in surgery-ineligible patients with locally advanced non-small cell lung cancer. Method 72 cases of surgery-inel-igible patients with local advanced non-small cell lung cancer confirmed by histopathological examination or immunohis-tochemistry tests were selected. The characteristics of brain metastases after radiotherapy in surgery-ineligible patients with locally advanced non-small cell lung cancer were analyzed according to the data, and risk factors for brain metasta-ses in those patients were analyzed with multivariate Logistic regression analysis. Result Among the 72 cases, 15 cases (20.83%) had brain metastases with 14 cases of adenocarcinoma and 1 case of squamous cell carcinoma;There were 2 cases with only brain metastases, and 13 cases with cancer metastasized to both brain metastases and other part(s) of the body. The median time to brain metastases was 8.5 months, and 1-and 3-year cumulative incidences of brain metastases were 16.31%and 29.94%. The results of univariate analysis showed that age, smoking history, CA125, NSE and CEA can in some way impact brain metastases following thoracic radiotherapy in patients with locally advanced non-small cell lung cancer (P<0.05). Multivariate Logistic regression analysis showed that age>60 years old, history of smoking, ele-vated CA125 level, elevated NSE level and non-squamous cell carcinoma were risk factors for brain metastases following thoracic radiotherapy in patients with locally advanced non-small cell lung cancer. Conclusion Age>60 years old, the history of smoking, elevated CA125 level, elevated NSE level, and non-squamous cell carcinoma are risk factors for brain metastases following thoracic radiotherapy in patients with locally advanced non-small cell lung cancer.