CAJ | 학술논문

目的：非小细胞肺癌患者经手术治疗后仍然面临脑转移的风险。文中旨在探讨非小细胞肺癌患者术后发生脑转移的临床特征和危险因素。方法回顾性分析成都市第三人民医院2008年2月至2012年2月收治的213例行外科手术的非小细胞肺癌患者的临床及随访资料，观察不同特征的非小细胞肺癌患者术后脑转移发生情况，采用Cox回归模型探讨患者术后出现脑转移的危险因素。结果全组累积脑转移发生率为23．9％（51／213），术后1、2、3年脑转移率依次为6．1％、14．1％、22．5％。单因素分析显示，不同年龄段、病理类型、肿瘤分期、癌胚抗原（carcino-embryonic antigen， CEA）水平的非小细胞肺癌患者术后脑转移率差异有统计学意义（P＜0．05）。 Cox回归分析显示，肺腺癌（HR＝2．00，95％CI：1．11～3．64）、肺癌Ⅲ期（HR＝3．70，95％CI：1．67～8．25）和术前CEA升高（≥5．0μg／L）（HR＝3．16，95％CI：1．60～6．25）为非小细胞肺癌患者术后脑转移的危险因素。脑转移患者生存率明显低于无脑转移患者生存率（29．4％ vs 54．9％， P＜0．05）。结论病理类型为肺腺癌、术后分期Ⅲ期的晚期患者、CEA升高的非小细胞肺癌患者术后发生脑转移的风险增加，应作为预防性脑放射的重点对象。
목적：비소세포폐암환자경수술치료후잉연면림뇌전이적풍험。문중지재탐토비소세포폐암환자술후발생뇌전이적림상특정화위험인소。방법회고성분석성도시제삼인민의원2008년2월지2012년2월수치적213례행외과수술적비소세포폐암환자적림상급수방자료，관찰불동특정적비소세포폐암환자술후뇌전이발생정황，채용Cox회귀모형탐토환자술후출현뇌전이적위험인소。결과전조루적뇌전이발생솔위23．9％（51／213），술후1、2、3년뇌전이솔의차위6．1％、14．1％、22．5％。단인소분석현시，불동년령단、병리류형、종류분기、암배항원（carcino-embryonic antigen， CEA）수평적비소세포폐암환자술후뇌전이솔차이유통계학의의（P＜0．05）。 Cox회귀분석현시，폐선암（HR＝2．00，95％CI：1．11～3．64）、폐암Ⅲ기（HR＝3．70，95％CI：1．67～8．25）화술전CEA승고（≥5．0μg／L）（HR＝3．16，95％CI：1．60～6．25）위비소세포폐암환자술후뇌전이적위험인소。뇌전이환자생존솔명현저우무뇌전이환자생존솔（29．4％ vs 54．9％， P＜0．05）。결론병리류형위폐선암、술후분기Ⅲ기적만기환자、CEA승고적비소세포폐암환자술후발생뇌전이적풍험증가，응작위예방성뇌방사적중점대상。
Objective The patients with non-small cell lung cancer ( NSCLC) are still at risk of brain metastasis after surgi-cal treatment.The study was to investigate the clinical characteristics and the risk factors for postoperative brain metastasis in patients with NSCLC in order to provide references for prophylactic cranial irradiation ( PCI) . Methods The clinical and prognostic data of 213 patients with NSCLC in our department of oncology from February 2008 to February 2012 were retrospectively analyzed.The occur-rences of postoperative brain metastasis in NSCLC patients with different characteristics were observed.Cox model was used to investi-gate the risk factors for postoperative brain metastasis in patients with NSCLC. Results The overall cumulative rate of brain metasta-sis was 23.9%(51/213) and the rates of brain metastasis at 1-year, 2-year, 3-year after surgery were 6.1%, 14.1%, 22.5% re-spectively.Univariate analysis showed that the rates of postoperative brain metastasis in NSCLC patients with different ages, histological types, tumor stages and CEA levels were statistically significant (P<0.05).Cox regression showed that adenocarcinoma (HR=2.00, 95%CI:1.11~3.64), lung cancer stageⅢ(HR=3.70, 95%CI:1.67~8.25) and high CEA (≥5.0μg/L)(HR=3.16, 95%CI:1.60~6.25) were risk factors for postoperative brain metastasis in patients with NSCLC.The survival time in NSCLC patients with brain metastasis was remarkably lower than that in patients without brain metastasis (P<0.05). Conclusion The NSCLC pa-tients with adenocarcinoma, III stage disease, or high CEA are more likely to develop brain metastasis after surgery, which should be the focus of PCI.