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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (7): 61-66.doi: 10.6040/j.issn.1671-7554.0.2016.1606

• 临床医学 • 上一篇    下一篇

局限期小细胞肺癌患者预防性脑照射后脑转移的关联分析:双中心研究

曾海燕1,2*,李睿3*,孙新东2,4,谢鹏2,4,孟雪2,4,范秉杰2,4,李万龙2,4,袁双虎2,4   

  1. 1.济南大学山东省医学科学院生命与科学学院, 山东 济南 250022;2.山东大学附属山东省肿瘤医院放疗科, 山东 济南 250117;3.四川省肿瘤医院放疗科, 四川 成都 610041;4.山东省医学科学院, 山东 济南 250022
  • 收稿日期:2016-12-03 出版日期:2017-07-10 发布日期:2017-07-10
  • 通讯作者: 袁双虎. E-mail:yuanshuanghu@sina.com*并列第一作者. E-mail:yuanshuanghu@sina.com
  • 基金资助:
    国家自然科学基金(81372413,81502667);山东省自然科学基金(ZR2014HP041);山东省重点研发计划(2016GSF201167);公益性行业科研专项(201402011)

Association analysis of brain metastases after prophylactic cranial irradiation in local disease small cell lung cancer: a bicenter study

ZENG Haiyan1,2*, LI Rui3*, SUN Xindong2,4, XIE Peng2,4, MENG Xue2,4, FAN Bingjie2,4, LI Wanlong2,4, YUAN Shuanghu2,4   

  1. 1. School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250022, Shandong, China;
    2. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, China;
    3. Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, Sichuan, China;
    4. Shandong Academy of Medical Sciences, Jinan 250022, Shandong, China
  • Received:2016-12-03 Online:2017-07-10 Published:2017-07-10

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摘要： 目的 探讨局限期小细胞肺癌(LD-SCLC)患者进行预防性脑照射(PCI)后脑转移的高危因素,建立风险模型,指导临床进一步完善综合治疗策略。 方法 收集2003年7月至2014年6月接受PCI的LD-SCLC患者257例。采用Kaplan-Meier法计算无脑转移生存期和总生存期。Cox回归分析脑转移的影响因素并建立风险模型。 结果 中位随访时间34个月,47例(18.3%)出现脑转移。单因素分析显示,一般状态评分(PS)(P=0.040)及胸部放疗方式(P=0.001)与脑转移呈显著相关。多因素分析显示,PS>1分(P=0.017)、胸部加速超分割(P=0.004)、任何治疗开始时间至放疗结束时间(SER)较长(P=0.035)是脑转移独立危险因素,手术是脑转移独立保护因素(P=0.035)。总生存独立保护因素为手术、胸部放疗生物等效剂量(TRTBED)大于51.04 Gy;独立危险因素为年龄≥60岁、PS>1分、PCI高于标准剂量。 结论 一般状态较差、胸部加速超分割、SER较长增加LD-SCLC患者PCI后脑转移风险。高剂量的PCI不仅未降低脑转移,而且会缩短总生存期。

关键词: 高危因素, 风险模型, 局限期小细胞肺癌, 预防性脑照射, 脑转移

Abstract: Objective To explore the risk factors for brain metastases(BM)after prophylactic cranial irradiation(PCI)and to develop a hazard model to guide the clinical practice in local-disease small cell lung cancer(LD-SCLC). Methods The clinical data of 257 LD-SCLC cases treated during July 2003 and June 2014 were retrieved. BM free survival(BMFS)and overall survival(OS)were estimated using Kaplan-Meier method. High risk factors and the 山 东 大 学 学 报 (医 学 版)55卷7期 -曾海燕,等.局限期小细胞肺癌患者预防性脑照射后脑转移的关联分析:双中心研究 \=-hazard model for BM were identified using Cox regression analyses. Results During the median follow-up of 34 months, BM occurred in 47(18.3%)patients. Univariate analyses indicated that performance status(PS)(P=0.040)and thoracic radiotherapy schedule(P=0.001)were associated with BM. Multivariate analyses showed that PS>1(P=0.017), thoracic hyperfractionated accelerated radiotherapy(HART)(P=0.004), and long duration of radiotherapy(SER)(P=0.035)were independent risk factors for BM, and surgery(P=0.035)was the independent protective factor for BM. In addition, surgery and thoracic radiotherapy biological effective dose(BED)were independent protective factors for OS, while age≥60 yr, PS>1 and PCI above standardized dosage were independent risk factors for OS. Conclusion Poor PS, thoracic HART and long SER are independent risk factors for BM after PCI in LD-SCLC. High dose of PCI does not prolong BMFS but shortens OS.

Key words: Prophylactic cranial irradiation, Risk factor, Brain metastasis, Hazard model, Local-disease small cell lung cancer

中图分类号: 

  • R734.2
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