论文部分内容阅读
目的:本文探讨完整切除ⅢA期非小细胞肺癌(Non-small-cell lung cancer,NSCLC)术后高危脑转移的临床特征,分析ⅢA期NSCLC患者行预防性脑放射的指征。方法:对193例完整切除术后的ⅢA期NSCLC患者进行回顾性分析,观察术后是否出现脑转移对生存的影响,并分析患者的临床资料,找出ⅢA期NSCLC术后脑转移的高危临床因素。结果:全组患者的中位生存期为829(16～3092)天,累计1、2、3、4、5年生存率分别为80.3%、54.8%、37.6%、29.7%和21.9%。整个病程出现脑转移的患者有67例(34.7%),第1、2、3年脑转移发生率分别为15.0%、31.5%、40.1%。终生有脑转移患者的总生存和无复发生存均明显差于终生无脑转移的患者(P=0.011和P=0.0004),两者的中位生存期分别为700天和928天,终身是否出现脑转移是影响预后的重要独立因素(P=0.04,HR=1.546,95%CI:1.020～2.343)。Cox预后多因素回归分析发现影响脑转移的因素为术前血清学CEA水平(P=0.014,HR=2.152,95%CI:1.169～3.963),是否鳞癌(P=0.021,HR=0.400,95%CI:0.184～0.873)。结论:终身是否出现脑转移是影响预后的重要独立因素,ⅢA期术后脑转移高危因素为术前血清学CEA升高和病理类型为非鳞癌。
Objective: This study was to investigate the clinical features of high-risk brain metastases after complete resection of stage Ⅲ A non-small-cell lung cancer (NSCLC) and to analyze the indications of prophylactic brain radiation in stage Ⅲ A NSCLC. Methods: A total of 193 patients with stage Ⅲ A NSCLC undergoing complete resection were retrospectively analyzed. The effect of brain metastasis on the survival was observed. The clinical data of the patients were analyzed to find out the high risk of brain metastasis in stage Ⅲ A NSCLC factor. Results: The median survival time was 829 (16-3092) days in all patients. The cumulative survival rates at 1, 2, 3, 4 and 5 years were 80.3%, 54.8%, 37.6%, 29.7% and 21.9%, respectively. 67 cases (34.7%) had brain metastasis in the whole course of disease, and the incidence of brain metastases in the first, second and third year were 15.0%, 31.5% and 40.1% respectively. The overall survival and recurrence-free survival of patients with brain metastasis over the lifetime were significantly lower than those without lifetime brain metastases (P = 0.011 and P = 0.0004). The median survival time was 700 days and 928 days, respectively, Brain metastasis was an important independent prognostic factor (P = 0.04, HR = 1.546, 95% CI: 1.020-2.343). Cox regression analysis showed that preoperative serum CEA levels (P = 0.014, HR = 2.152, 95% CI: 1.169-3.963), squamous cell carcinoma (P = 0.021, HR = 0.400, 95% % CI: 0.184 ~ 0.873). Conclusion: Brain metastasis is an important independent prognostic factor for lifelong. The high risk factors for postoperative brain metastases in stage ⅢA are preoperative serum CEA elevation and non-squamous cell carcinoma.