摘要
目的:探讨不同治疗模式对非小细胞肺癌(NSCLC)脑转移患者生存的影响,评估诊断特异性分析预后评估(DS-GPA)模型和肺肿瘤相关分子分级预后评估(Lung-molGPA)模型的临床价值。方法:回顾性分析2011年1月至2015年12月汕头大学医学院附属肿瘤医院收治的195例NSCLC脑转移患者临床资料,患者包括初诊未发生脑转移(异时性脑转移)112例、初诊已有脑转移(同时性脑转移)83例。采用单纯颅脑放疗、化疗、靶向药物治疗、化疗+颅脑放疗、化疗+靶向药物+颅脑放疗、靶向药物+颅脑放疗、化疗+靶向药物等方式治疗。采用Kaplan-Meier法进行生存分析,Cox回归法进行单因素及多因素生存分析,应用DS-GPA和Lung-molGPA模型进行生存分析。结果:NSCLC异时性脑转移患者中位至脑转移时间14.1个月(95% CI 12.2~16.0个月);全组患者中位脑转移无进展生存(PFS BM)时间4.3个月(95% CI 3.4~5.2个月),中位脑转移总生存(OS BM)时间6.7个月(95% CI 4.6~8.8个月),同时性、异时性脑转移患者间PFS BM和OS BM差异均无统计学意义( P=0.446、 P=0.080)。抗肿瘤治疗,尤其联合靶向药物治疗模式,能改善患者中位OS BM。Karnofsky评分低( RR=1.698,95% CI 1.238~2.329, P=0.001)和骨转移( RR=1.505,95% CI 1.089~2.081, P=0.013)为NSCLC脑转移患者OS BM独立危险因素,化疗( RR=0.460,95% CI 0.289~0.731, P=0.001)和颅脑放疗( RR=0.541,95% CI 0.391~0.749, P<0.01)为NSCLC脑转移患者OS BM独立保护因素。按照DS-GPA和Lung-molGPA模型分组患者的生存差异均有统计学意义(DS-GPA 0.0~1.0、1.5~2.0、2.5~3.0分患者的中位OS BM时间分别为4.2、9.4、10.9个月, P=0.015;Lung-molGPA 0.0~1.0、1.5~2.0、2.5~3.0分患者的中位OS BM时间分别为4.1、8.7、13.0个月, P<0.01)。 结论:NSCLC脑转移患者预后差,接受抗肿瘤治疗可延长其生存期。Karnofsky评分高、无骨转移、接受化疗和颅脑放疗是NSCLC脑转移的独立预后良好因素。DS-GPA和Lung-molGPA模型均能预测NSCLC脑转移患者的生存情况。
Objective To investigate the effects of different treatment modes on the survival of patients with non-small cell lung cancer(NSCLC)brain metastases,and to evaluate the clinical values of diagnosis-specific graded prognostic assessment(DS-GPA)model and graded prognostic assessment model for lung cancer using molecular markers(Lung-molGPA).Methods The clinical data of 195 NSCLC patients with brain metastases treated in the Cancer Hospital of Shantou University Medical College from January 2011 to December 2015 were retrospectively analyzed,including 112 patients without brain metastasis(metachronous brain metastases)at the first diagnosis,and 83 patients with brain metastases at the first diagnosis(simultaneous brain metastases).The treatment modalities of brain metastases included single local cranial radiation,chemotherapy,target therapy and combined cranial radiation with chemotherapy or target therapy,chemotherapy plus target therapy,et al.Kaplan-Meier method was used for survival analysis,Cox regression method was used for univariate and multivariate survival analyses,and DS-GPA and Lung-molGPA models were used for survival analysis.Results The median time to brain metastases in all patients was 14.1 months(95%CI 12.2-16.0 months).The median progression-free survival(PFSBM)time of all patients was 4.3 months(95%CI 3.4-5.2 months),and the median overall survival(OSBM)time of brain metastases was 6.7 months(95%CI 4.6-8.8 months).There was no difference in PFSBM and OSBM between patients with synchronous and metachronous brain metastases(P=0.446,P=0.080).Receiving anti-tumor therapy,especially combining targeted therapy could improve median OSBM.Low Karnofsky score(RR=1.698,95%CI 1.238-2.329,P=0.001)and bone metastasis(RR=1.505,95%CI 1.089-2.081,P=0.013)were independent risk factors for the OSBM of NSCLC patients with brain metastases,and chemotherapy(RR=0.460,95%CI 0.289-0.731,P=0.001)and brain radiotherapy(RR=0.541,95%CI 0.391-0.749,P<0.01)were independent protective factors for the OSBM of NSCLC patients with brain metastases.The OSBM difference between patients grouped by DS-GPA and Lung-molGPA models was statistically significant(median OSBM time of patients with DS-GPA model 0.0-1.0,1.5-2.0 and 2.5-3.0 points were 4.2,9.4 and 10.9 months,respectively,P=0.015;median OSBM time of patients with Lung-molGPA model 0.0-1.0,1.5-2.0 and 2.5-3.0 points were 4.1,8.7 and 13.0 months,respectively,P<0.01).Conclusions The prognosis of NSCLC patients with brain metastases is poor,and anti-tumor therapy can prolong their survival.High Karnofsky score,without bone metastasis,receiving chemotherapy or brain radiotherapy are independent good prognostic factors for NSCLC patients with brain metastases.Both DS-GPA and Lung-molGPA models can predict the survival of NSCLC patients with brain metastases.
作者
陈火光
王鸿彪
池秀盈
林英城
Chen Huoguang;Wang Hongbiao;Chi Xiuying;Lin Yingcheng(Department of Medical Oncology,Cancer Hospital of Shantou University Medical College,Shantou 515000,China;Cancer Center,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,China)
出处
《肿瘤研究与临床》
CAS
2020年第11期753-759,共7页
Cancer Research and Clinic
关键词
癌
非小细胞肺
脑肿瘤
肿瘤转移
预后
模型
统计学
Carcinoma,non-small-cell lung
Brain neoplasms
Neoplasm metastasis
Prognosis
Models,statistical
