手术治疗非小细胞肺癌合并孤立脑转移灶的回顾性临床观察

目的 研究外科手术治疗非小细胞肺癌 (NSCLC)合并孤立性脑转移灶(SBM)的有效性和生存期。方法 本研究为临床资料的回顾性观察研究。收集 2008 年1月~2014 年6月笔者科室收治的NSCLC伴随SBM病例52例, 52例患者均行原发灶及脑内转移灶肿瘤根治性切除术, 其中, 女性14例, 男性38例;患者年龄36~71岁, 平均年龄53.25±14.39岁;手术中6例为全肺切除, 46 例为部分肺叶切除, 术后所有患者均联合脑部放疗(WBRT), 41例患者行联合化疗3~6个周期。随访所有患者收集其生存时间, 进行Log-rank test分析其生存率。结果 肿瘤组织病理报告示鳞癌18例, 腺癌30例, 大细胞癌2例, 其他肿瘤类型 2 例。患者平均生存期28.61±4.17个月(kaplan-meier法), 中位生存期24个月;1、2、3年生存率分别为 81.47%、40.73%、15.26%。Log-rank test结果示腺癌患者生存期长于非腺癌患者(P=0.002), 纵隔淋巴结转移为N₀和N₁者生存率高于 N₂者(P=0.026)。结论 非小细胞肺癌合并孤立性脑转移灶的手术有确切的临床疗效, 其中, 淋巴结转移为N₀、N₁和腺癌患者生存期更长。

A Retrospective Clinical Observation of Surgical Treatment for Non-Small Cell Lung Cancer Combined with Solitary Brain Metastases

Objective To investigate the effectiveness and the survival of the patients who got the non-small cell lung cancer (NSCLC) combined with solitary brain metastasis (SBM) after surgeries. Methods This was a retrospective study. Clinical data of 52 patients with both NSCLC and SBM were collected from January 2008 to June 2014. All of them were treated with the resection of the primary and the brain's metastasis tumor. There were 14 females and 38 males with the age from 36 to 71 years old, and the mean age accounting for 53.25±14.39 years old. Six patients twere reated with pneumonectomy, and the other 46 patients got partial lobectomy. All the patients were taken brain WBRT after surgeries, of which 41 patients accomplished 3 to 6 chemotherapy cycles. Their survival times were collected, and then the survival rate was analyzed with Logrank test. Results The pathological report of the tumor tissue revealed that the number of the squamous cell carcinoma, adenocarcinoma, large cell carcinoma and other tumor types amounted to 18, 30, 2 and 2 accordingly. The average survival time was 28.61±4.17 months (kaplan-meier method), with a median survival of 24 months. The survival rates after 1, 2 and 3years accounted for 81.47%, 40.73% and 15.26% respectively. The results from Log-rank test presented that the patients with adenocarcinoma had a longer survival time than those with non-adenocarcinoma(P=0.002), and the survival rate of mediastinal lymph node metastasis of N₀ and N₁ were higher than N₂(P=0.026). Conclusion Surgical treatment is of a significant curative effect for non-small cell lung cancer combined with solitary brain metastasis. Patients with adenocarcinoma or lymph node metastasis of N₀ and N₁ have a longer survival time.