CAJ | 학술논문

目的分析小细胞肺癌根治术后脑转移的影响因素,探讨术后脑预防照射意义.方法对本院2000-2009年收治的有完整记录的88例行根治性手术治疗的小细胞肺癌患者资料行回顾性分析,Kaplan-Meier法生存分析,Logistic回归模型分析脑转移发生的影响因素.结果随访率100％,随访满3年者37例.3例行脑预防照射患者均未发生脑转移；85例未行脑预防照射者脑转移发生率为24％,其中Ⅰ、Ⅱ、Ⅲ期患者3年脑转移发生率分别为4％、26％、29％(x2=7.57,P=0.023).发生脑转移与未发生脑转移患者的中位生存时间分别为18个月和48个月,3年生存率分别为25％和59％(x2=10.63,P=0.001).全组患者单因素及多因素回归分析均显示疗前分期是脑转移的影响因素(x2 =7.57、8.52,P=0.023、0.004),而年龄、性别、肿瘤部位、病理类型、术前化疗、术后放/化疗均不是脑转移的影响因素(x2 =0.03、0.00、0.00、2.58、0.01、1.23、0.84,P=0.869、0.998、0.992、0.109、0.936、0.266、0.361).结论疗前分期是小细胞肺癌根治术后脑转移的影响因素.Ⅰ期小细胞肺癌脑转移率低、总生存期较长、术后行脑预防照射意义不大,Ⅱ、Ⅲ期患者脑转移率高、发生脑转移后预后差、建议行脑预防照射.
목적 분석소세포폐암근치술후뇌전이적영향인소,탐토술후뇌예방조사의의.방법 대본원2000-2009년수치적유완정기록적88례행근치성수술치료적소세포폐암환자자료행회고성분석,Kaplan-Meier법생존분석,Logistic회귀모형분석뇌전이발생적영향인소.결과 수방솔100％,수방만3년자37례.3례행뇌예방조사환자균미발생뇌전이；85례미행뇌예방조사자뇌전이발생솔위24％,기중Ⅰ、Ⅱ、Ⅲ기환자3년뇌전이발생솔분별위4％、26％、29％(x2=7.57,P=0.023).발생뇌전이여미발생뇌전이환자적중위생존시간분별위18개월화48개월,3년생존솔분별위25％화59％(x2=10.63,P=0.001).전조환자단인소급다인소회귀분석균현시료전분기시뇌전이적영향인소(x2 =7.57、8.52,P=0.023、0.004),이년령、성별、종류부위、병리류형、술전화료、술후방/화료균불시뇌전이적영향인소(x2 =0.03、0.00、0.00、2.58、0.01、1.23、0.84,P=0.869、0.998、0.992、0.109、0.936、0.266、0.361).결론 료전분기시소세포폐암근치술후뇌전이적영향인소.Ⅰ기소세포폐암뇌전이솔저、총생존기교장、술후행뇌예방조사의의불대,Ⅱ、Ⅲ기환자뇌전이솔고、발생뇌전이후예후차、건의행뇌예방조사.
Objective To evaluate clinical risk factors that can predict brain metastasis after complete resection of small cell lung cancer (SCLC) and to assess the role of prophylactic cranial irradiation (PCI) in such kind of patients.Methods Eighty-eight patients with completely resected stage Ⅰ - Ⅲ SCLC from Jan.2000 to Dec.2009 in our hospital were retrospectively analyzed.Kaplan-Meier was used to compare the differences in the incidence of metastasis free survival in different groups.Logistic model was used to assess the independent risk factors for brain metastasis.Results The follow-up rate is 100％,and 37 patients were followed up for more than three years.None of the 3 patients who received PCI developed brain metastasis,while for patients without receiving PCI,24％ developed brain metastases.The incidence of brain metastasis for stage Ⅰ,Ⅱ and Ⅲ SCLC after surgery were 4％,26％ and 29％ ( x2 =7.57,P =0.023),respectively.The median survival time and the 3-year survival rate were 18 months and 25％ for patients who developed brain metastasis,and 48 months and 59％ for those without brain metastasis ( x2 =10.63,P =0.001 ).Both univariate and multivariate analyses showed that pre-treatment disease stage wasindependent risk factor for brain metastasis ( x2 =7.57,8.52 ; P =0.023,0.004 ).Age,sex,tumor location,pathological type,induction chemotherapy,and postoperative chemotherapy/radiotherapy were not significantly correlated with the incidence of brain metastasis ( x2 =0.03,0.00,0.00,2.58,0.01,1.23,0.84;P =0.869,0.998,0.992,0.109,0.936,0.266,0.361,respectively).Conclusions Pre-treatment disease stage was independent risk factor for brain metastasis in SCLC.PCI may be important for stage Ⅱ -Ⅲ SCLC but not for stage Ⅰ disease.<英文关键词>=Carcinoma,small cell lung/surgery; Neoplasm metastasis,brain/prophylactic irradiation; Factors analysis