伽玛刀治疗81例肺癌脑转移瘤的疗效及预后因素

目的 评估伽玛刀治疗肺癌脑转移瘤患者的疗效,分析影响生存预后的相关因素。 方法 选取2016年5月至2020年6月在我院神经外科接受伽玛刀治疗的81例肺癌脑转移瘤患者进行回顾性研究,随访后建立临床资料数据库。总生存期定义为从患者接受伽玛刀治疗到死亡或末次随访日期或第一次失访日期的时间间隔。使用 Kaplan-Meier法计算患者中位生存期、6个月、1年、2年的生存率,并绘制生存曲线。通过log-rank检验行单因素生存分析,检验各因素组间生存率的差异。采用Cox回归模型行多因素分析影响生存预后的不同因素。 结果 所有患者均获得随访,截至末次随访日期,81例患者中36例死亡(44.44%),伽玛刀治疗后的中位总生存期为23个月(95%CI=14~26)。6个月、1年、2年的总生存率分别为82.84%、63.53%、43.35%。结合单因素和多因素分析结果,转移灶总体积(HR=1.158,95%CI=1.079~1.242, P<0.001)、年龄(HR=2.666,95%CI=1.257~5.657,P=0.010 6)及边缘剂量(HR=0.392,95%CI=0.167-0.922,P=0.031 8)是影响生存的预后因素。结论 本项研究中接受伽玛刀治疗的肺癌脑转移瘤患者,生存率得到了提高、生存期得到了延长,收获了良好的疗效。转移灶总体积≥16 cm³、年龄≥70岁及给与边缘剂量<17Gy是预后不利因素,且差异有统计学意义(P<0.05)。

Efficacy and prognostic factors of gamma knife in treating 81 cases of brain metastases from lung cancer

Objective To evaluate the efficacy of gamma knife in the treatment of brain metastases from lung cancer and to analyze factors affecting survival. Methods A total of 81 patients with brain metastases from lung cancer who received gamma knife treatment in the Neurosurgery Department of our hospital during May 2016 and June 2020 were selected for a retrospective study, and a database was established after follow-up. Overall survival was defined as the period from the time receiving gamma knife to the date of death or end of follow-up or the first loss of follow-up. The 6-month, 1-year and 2-year survival rate were calculated with Kaplan-Meier method, and the survival curve was plotted. The differences in survival rates were analyzed with Log-rank test. Factors affecting survival were analyzed with Cox multivariate regression. Results All patients were followed up, and 36 of the 81 patients died(44.44%)at the end of follow-up. The median overall survival was 23 months(95%CI: 14~26). The 6-month, 1-year and 2-year survival rate were 82.84%, 63.53% and 43.35%, respectively. The total volume of metastases(HR: 1.158, 95%CI: 1.079~1.242, P<0.001), age(HR: 2.666, 95%CI: 1.257~5.657, P=0.010 6), and marginal dose(HR: 0.392, 95%CI: 0.167~0.922, P=0.031 8) were factors affecting survival. Conclusions Patients with brain metastases from lung cancer who received gamma knife treatment in this study gained good efficacy, and their survival rate and survival time were improved. The total volume of metastases ≥16cm3, age ≥70 years, and marginal dose <17Gy were adverse prognostic factors(P<0.05).