局限期小细胞肺癌完全切除预后及脑转移高危因素分析

doi:10.3760/cma.j.cn113030-20220516-00180

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摘要目的分析局限期小细胞肺癌（LS‐SCLC）患者完全切除术后预后及脑转移（BM）的高危因素,以筛选最可能从预防性颅脑照射（PCI）中获益的患者。方法回顾性分析2005年1月至2018年12月河北省沧州中西医结合医院收治的行完全切除的LS‐SCLC患者94例,其中31例接受PCI治疗,63例未接受PCI治疗。使用Kaplan‐Meier法分析预后及脑转移的相关因素,并使用log‐rank检验分析组间差异。采用多因素Cox回归模型分析总生存（OS）及BM的独立危险因素。结果 PCI组2、5年OS率为80.6%、61.3%,非PCI组分别为61.9%、46.0%（P=0.001）。PCI组2、5年无脑转移生存（BMFS）率为80.6%、54.8%,非PCI组分别为57.1%、42.9%（P=0.045）。PCI组2、5年无进展生存（PFS）率为71.0%、48.4%,非PCI组分别为49.2%、34.9%（P=0.016）。PCI可提高pⅡ/Ⅲ期患者OS（P=0.039,P=0.013）,但pⅠ期患者OS获益不显著（P=0.167）。PCI组有3例（9.7%）患者发生BM,明显低于非PCI组（17例,27.0%;P=0.044）;在pⅠ期、pⅡ期患者中,PCI组和非PCI组BM发生率的差异无统计学意义（P=0.285;P=0.468）;而pⅢ期患者中,PCI组BM发生率明显低于非PCI组（P=0.041）。多因素分析显示,年龄≥60岁（HR=2.803,P=0.001）、BM（HR=2.239,P=0.022）、未行PCI（HR=0.341,P=0.004）、病理分期pⅡ/Ⅲ期（HR=4.963,P=0.002）是影响OS的独立高危因素;而病理分期pⅡ/Ⅲ期（HR=11.665,P=0.007）是影响BM的独立高危因素。结论 LS‐SCLC完全切除术后pⅡ‐Ⅲ期患者发生BM的风险较高、预后较差,应接受PCI治疗,而pⅠ期患者可能获益不显著。

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	周建西
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关键词 ：小细胞肺癌,局限期, 预后, 脑转移, 预防性颅脑照射, 高危因素

Abstract：Objective To analyze the prognosis and risk factors for brain metastases (BM) in patients with limited‐stage small cell lung cancer (LS‐SCLC) after complete resection, aiming to identify those most likely to benefit from prophylactic cranial irradiation (PCI). Methods Clinical data of 94 patients with LS‐SCLC treated in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2005 to December 2018 who underwent complete resection were retrospectively analyzed, including 31 cases treated with PCI and 63 without PCI. Prognostic factors and risk factors of BM were analyzed by Kaplan‐Meier method. The differences between two groups were analyzed by log‐rank test. Independent risk factors of overall survival (OS) and BM were assessed by multivariate Cox regression model. Results The 2‐year and 5‐year OS rates were 80.6% and 61.3% in the PCI group, and 61.9% and 46.0% in the non‐PCI group, respectively (P=0.001). The 2‐year and 5‐year brain metastasis-free survival (BMFS) rates were 80.6% and 54.8% in the PCI group, and 57.1% and 42.9% in the non‐PCI group, respectively (P=0.045). The 2‐year and 5‐year progression-free survival (PFS) rates were 71.0% and 48.4% in the PCI group, and 49.2% and 34.9% in the non‐PCI group, respectively (P=0.016). PCI could improve OS in patients with pII/III stage LS‐SCLC (P=0.039, P=0.013), but the OS benefit in patients with pI stage LS‐SCLC was not significant (P=0.167). BM occurred in 3 patients (9.7%) in the PCI group, which was significantly lower than that in the non‐PCI group (n=17, 27.0%; P=0.044); there was no significant difference in the BM rate of patients with pI and pII stage LS‐SCLC between PCI and non‐PCI groups (P=0.285, P=0.468); and the BM rate of patients with pIII stage LS‐SCLC in the PCI group was significantly lower than that in the non‐PCI group (P=0.041). Multivariate analysis showed age ≥60 (HR=2.803, P=0.001), BM (HR=2.239, P=0.022), no PCI (HR=0.341, P=0.004) and pathological stage pII/III (HR=4.963, P=0.002) were the independent high‐risk factors affecting OS; and pathological stage pII/III (HR=11.665, P=0.007) was an independent high‐risk factor affecting BM. Conclusions LS‐SCLC patients with pII‐III stage have a higher risk of developing BM and poor prognosis after complete resection, and should receive PCI treatment. However, LS‐SCLC patients with pI stage may not benefit significantly.

Key words： Small cell lung carcinoma,limited‐stage Prognosis Brain metastases Prophylactic cranial irradiation High risk factors

收稿日期: 2022-05-16

通讯作者: 孙云川,Email：sunyunchuan@163.com

引用本文:

周建西,孙云川,肖丽等. 局限期小细胞肺癌完全切除预后及脑转移高危因素分析[J]. 中华放射肿瘤学杂志, 2023, 32(3): 207-214.

Zhou Jianxi,Sun Yunchuan,Xiao Li et al. Prognosis and risk factors of brain metastases from limited‐stage small cell lung cancer after complete resection[J]. Chinese Journal of Radiation Oncology, 2023, 32(3): 207-214.

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