摘要
目的探讨肺腺鳞癌脑转移患者术后预后的相关因素。方法通过美国监测、流行病学和结局数据库(SEER数据库),收集2010年—2019年肺腺鳞癌仅发生脑转移的185例患者,根据2019年的随访结果将肺腺鳞癌脑转移患者分为手术组(38例)和未手术组(147例),并回顾中国医学科学院北京协和医学院肿瘤医院2例伴有脑转移的肺腺鳞癌患者的临床资料,对比分析影响患者总生存期(OS)的相关因素。运用单因素与多因素Cox回归分析影响患者脑转移术后预后的独立危险因素,并分析独立危险因素的KM生存曲线。结果185例脑转移患者的中位OS为6个月。单纯手术患者中位OS为3个月,手术联合放疗、化疗患者的中位OS为10个月,差异有统计学意义(P=0.002)。单因素分析结果显示,年龄(HR=0.302,95%CI:0.137~0.663,P=0.003)、有无脑转移术后放疗(HR=2.242,95%CI:1.093~4.599,P=0.028)、有无化疗(HR=4.166,95%CI:1.911~9.081,P=0.000)、治疗方式(HR=3.307,95%CI:1.556~7.027,P=0.002)是影响脑转移手术患者OS的因素;有无原发部位手术(HR=2.963,95%CI:1.486~5.908,P=0.002)、有无化疗(HR=1.843,95%CI:1.286~2.640,P=0.001)是影响脑转移未手术患者OS的因素。多因素分析结果显示,有无化疗(HR=0.247,95%CI:0.077~0.791,P=0.019)是影响脑转移手术患者OS的独立预后因素;有无原发部位手术(HR=2.877,95%CI:1.477~5.718,P=0.003)、有无化疗(HR=0.551,95%CI:0.384~0.790,P=0.001)是影响脑转移未手术患者OS的独立预后因素。结论化疗和原发灶手术可以影响肺腺鳞癌脑转移患者的预后。
Objective To evaluate the prognosis-related factors after surgical operation of patients with brain metastasis of lung adenosquamous carcinoma.Methods A total of 185 patients with lung ASC who only had brain metastasis were collected from United States Surveillance,Epidemiology,and Final Results Registry(SEER database)from 2010 to 2019.According to the follow-up results in 2019,patients with lung adenosquamous carcinoma brain metastasis were divided into surgery group(n=38)and non-surgery group(n=147).The clinical data of 2 patients with lung adenosquamous carcinoma with brain metastasis in Cancer Hospital of Chinese Academy of Medical Sciences Peking Union Medical College were reviewed,and the related factors affecting overall survival(OS)were compared and analyzed.Univariate and multivariate Cox regression was used to analyze the independent risk factors affecting the prognosis of patients with brain metastasis,and the KM survival curve of independent risk factors was analyzed.Cox regression proportional hazard model was used in multivariate analysis to obtain the independent risk factors affecting the long-term prognosis of patients with brain metastasis of lung adenosquamous carcinoma.Results The median OS of 185 patients with brain metastasis was 6.0 months.The median OS of patients with surgery alone was 3.0 months,and that of patients with surgery combined with radiotherapy and chemotherapy was 10.0 months,the difference was statistically significant(P=0.001).The results of single factor analysis showed that age(HR=0.302,95%CI:0.137-0.663,P=0.003),postoperative radiotherapy for brain metastasis(HR=2.242,95%CI:1.093-4.599,P=0.028),chemotherapy(HR=4.166,95%CI:1.911~9.081,P=0.000),treatment modalities(HR=3.307,95%CI:1.556-7.027,P=0.002)were the factors affecting the OS of surgical patients with brain metastasis.And primary site operation(HR=2.963,95%CI:1.486-5.908,P=0.002),chemotherapy(HR=1.843,95%CI:1.286-2.640,P=0.001)were the factors affecting the OS of unoperated patients with brain metastasis.The results of multivariate analysis showed that chemotherapy(HR=0.247,95%CI:0.077~0.791,P=0.019)was an independent prognostic factor affecting OS in surgical patients with brain metastasis.Primary site operation(HR=2.877,95%CI:1.477-5.718,P=0.003),chemotherapy(HR=0.551,95%CI:0.384-0.790,P=0.001)were the independent prognostic factors of OS in unoperated patients with brain metastasis.Conclusion Chemotherapy and primary surgery can affect the prognosis of patients with brain metastasis of lung adenosquamous carcinoma.
作者
刘志丹
蔡洪庆
赵兵
王崧权
张广涛
方诚
万经海
LIU Zhidan;CAI Hongqing;ZHAO Bing(Department of Neurosurgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《临床神经外科杂志》
2023年第3期268-274,共7页
Journal of Clinical Neurosurgery
基金
中国医学科学院临床与转化医学研究专项项目(2022-I2M-C&T-B-063)。
关键词
肺腺鳞癌
脑转移
SEER数据库
预后
lung adenosquamous carcinoma
brain metastasis
SEER database
prognosis
