非小细胞肺癌伴脑转移放疗疗效分析

目的探讨非小细胞肺癌(NSCLC)伴脑转移全脑放疗的时机及预后影响因素。方法搜集147例NSCLC伴脑转移并行全脑放疗患者的临床资料,结合随访资料进行单因素和多因素Cox比例风险模型回归分析。结果颅外转移为NSCLC脑转移患者预后的独立影响因素,比值比(OR)为1.924,95%可信区间(CI)为1.356-2.728。颅外转移、确诊脑转移到全脑放疗的时间是有脑转移症状NSCLC患者预后的独立影响因素,OR分别为1.691和2.964,95%CI分别为1.003～2.850和1.674-5.248。颅外转移是无脑转移症状NSCLC患者预后的独立影响因素,OR为1.793,95%CI为1.099-2.925。结论颅外转移是影响NSCLC伴脑转移患者预后的重要因素,及早行全脑放疗有助于提高有脑转移症状的NSCLC脑转移患者的生存期。

Whole brain irradiation for non-small-cell lung cancer with brain metastasis

OBJECTIVE: To investigate the time of whole brain irradiation and the prognostic factors for non-small lung cancer patients with brain metastasis. METHODS: From August 1996 to December 2003, 147 patients with brain metastasis from non-small cell lung cancer received whole brain irradiation. The patients were divided into two groups: with or without symptoms caused by brain metastasis, each group was then divided into two sub-groups, early whole brain irradiation group (the interval between the diagnosis of brain metastasis and the brain irradiation < or = one month) and late group ( the interval > one month ). Univariate and multivariate analysis (Cox regression) as well as Kaplan-Meier method in SPSS software package 11.5 was used to analyze the data of the 147 patients including 72 with brain metastasis symptom and 75 without. RESULTS: The median survival time (MS) of patients with or without extracranial metastasis was 9.9 months and 11.3 months (P = 0.0002). Multivariate analysis indicated that extracranial metastasis was an independent prognostic factor (P = 0.0004). For 72 patients with brain metastasis symptom, the MS of the patients with and without extracranial metastasis was 9.3 months and 11.3 months (P = 0.0036). The MS of patients with early and late whole brain irradiation was 11.4 months and 9.2 months (P = 0.001). Multivariate analysis showed that extracranial metastasis, the interval between the diagnosis of brain metastasis and the whole brain irradiation were independent prognostic factors. However, for 75 patients without brain metastasis symptom, the MS difference of those with early or late whole brain irradiation was not statistically significant (P = 0.1643). CONCLUSION: The extracranial metastasis in non-small cell lung cancer patients with brain metastasis is an independent prognostic factors. Early whole brain irradiation may improve the survival for those with brain metastasis symptoms.