伽玛刀治疗81例肺癌脑转移瘤的疗效及预后因素

doi:10.6040/j.issn.1671-7554.0.2021.1380

摘要/Abstract

摘要： 目的评估伽玛刀治疗肺癌脑转移瘤患者的疗效,分析影响生存预后的相关因素。方法选取2016年5月至2020年6月在我院神经外科接受伽玛刀治疗的81例肺癌脑转移瘤患者进行回顾性研究,随访后建立临床资料数据库。总生存期定义为从患者接受伽玛刀治疗到死亡或末次随访日期或第一次失访日期的时间间隔。使用 Kaplan-Meier法计算患者中位生存期、6个月、1年、2年的生存率,并绘制生存曲线。通过log-rank检验行单因素生存分析,检验各因素组间生存率的差异。采用Cox回归模型行多因素分析影响生存预后的不同因素。结果所有患者均获得随访,截至末次随访日期,81例患者中36例死亡(44.44%),伽玛刀治疗后的中位总生存期为23个月(95%CI=14~26)。6个月、1年、2年的总生存率分别为82.84%、63.53%、43.35%。结合单因素和多因素分析结果,转移灶总体积(HR=1.158,95%CI=1.079~1.242, P<0.001)、年龄(HR=2.666,95%CI=1.257~5.657,P=0.010 6)及边缘剂量(HR=0.392,95%CI=0.167-0.922,P=0.031 8)是影响生存的预后因素。结论本项研究中接受伽玛刀治疗的肺癌脑转移瘤患者,生存率得到了提高、生存期得到了延长,收获了良好的疗效。转移灶总体积≥16 cm³、年龄≥70岁及给与边缘剂量<17Gy是预后不利因素,且差异有统计学意义(P<0.05)。

关键词: 伽玛刀, 立体定向放射外科, 脑转移瘤, 肺癌, 生存, 预后因素

Abstract: Objective To evaluate the efficacy of gamma knife in the treatment of brain metastases from lung cancer and to analyze factors affecting survival. Methods A total of 81 patients with brain metastases from lung cancer who received gamma knife treatment in the Neurosurgery Department of our hospital during May 2016 and June 2020 were selected for a retrospective study, and a database was established after follow-up. Overall survival was defined as the period from the time receiving gamma knife to the date of death or end of follow-up or the first loss of follow-up. The 6-month, 1-year and 2-year survival rate were calculated with Kaplan-Meier method, and the survival curve was plotted. The differences in survival rates were analyzed with Log-rank test. Factors affecting survival were analyzed with Cox multivariate regression. Results All patients were followed up, and 36 of the 81 patients died(44.44%)at the end of follow-up. The median overall survival was 23 months(95%CI: 14~26). The 6-month, 1-year and 2-year survival rate were 82.84%, 63.53% and 43.35%, respectively. The total volume of metastases(HR: 1.158, 95%CI: 1.079~1.242, P<0.001), age(HR: 2.666, 95%CI: 1.257~5.657, P=0.010 6), and marginal dose(HR: 0.392, 95%CI: 0.167~0.922, P=0.031 8) were factors affecting survival. Conclusions Patients with brain metastases from lung cancer who received gamma knife treatment in this study gained good efficacy, and their survival rate and survival time were improved. The total volume of metastases ≥16cm3, age ≥70 years, and marginal dose <17Gy were adverse prognostic factors(P<0.05).

Key words: Gamma knife, Stereotactic Radiosurgery, Brain metastases, Lung cancer, Survival, Prognostic factors

中图分类号:

R651.1+9

高中霞,张铭,樊明德,谭晨阳,王梦迪,王超,樊跃飞,丁守銮,王成伟. 伽玛刀治疗81例肺癌脑转移瘤的疗效及预后因素[J]. 山东大学学报 (医学版), 2022, 60(8): 44-49.

GAO Zhongxia, ZHANG Ming, FAN Mingde, TAN Chenyang, WANG Mengdi, WANG Chao, FAN Yuefei, DING Shouluan, WANG Chengwei. Efficacy and prognostic factors of gamma knife in treating 81 cases of brain metastases from lung cancer[J]. Journal of Shandong University (Health Sciences), 2022, 60(8): 44-49.

参考文献

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin,2018, 68(6): 394-424.
[2] Smedby KE, Brandt L, Bäcklund ML, et al. Brain metastases admissions in Sweden between 1987 and 2006 [J]. Br J Cancer, 2009, 101(11): 1919-1924.
[3] Berghoff AS, Schur S, Füreder LM, et al. Descriptive statistical analysis of a real life cohort of 2419 patients with brain metastases of solid cancers [J]. ESMO Open, 2016, 1(2): e000024. doi: 10.1136/esmoopen-2015-000024.
[4] Soffietti R, Kocher M, Abacioglu UM, et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results [J]. J Clin Oncol, 2013, 31(1): 65-72.
[5] 赵东海, 杜汉强, 王嘉嘉, 等. 伽玛刀治疗对脑转移瘤病人认知功能及生活质量影响的研究[J]. 中国微侵袭神经外科杂志, 2020, 25(5): 205-208. ZHAO Donghai, DU Hanqiang, WANG Jiajia, Effects of gamma knife treatment on cognitive function and quality of life in patients with brain metastases [J]. Chinese Journal of Minimally Invasive Neurosurgery,2020, 25(5): 205-208.
[6] 王嘉嘉, 赵东海, 梁军潮. 脑转移瘤的伽马刀治疗新进展[J]. 广东医学, 2019, 40(1): 24-26.
[7] Berghoff AS, Preusser M. New developments in brain metastases [J]. Ther Adv Neurol Disord, 2018, 11: 1756286418785502. doi: 10.1177/1756286418785502.
[8] Shen H, Deng G, Chen Q, et al. The incidence, risk factors and predictive nomograms for early death of lung cancer with synchronous brain metastasis: a retrospective study in the SEER database [J]. BMC Cancer, 2021, 21(1): 825.
[9] Soffietti R, Abacioglu U, Baumert B, et al. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology(EANO)[J]. Neuro Oncol, 2017, 19(2): 162-174.
[10] Protopapa M, Kouloulias V, Nikoloudi S, et al. From Whole-Brain Radiotherapy to Immunotherapy: A Multidisciplinary Approach for Patients with Brain Metastases from NSCLC [J]. J Oncol, 2019, 2019: 3267409. doi: 10.1155/2019/3267409.
[11] Spencer K, Hall A, Jain P. Brain metastases [J]. Clin Med(Lond), 2014, 14(5): 535-537.
[12] 董耀东, 魏薇, 马秀岚. 立体放射治疗技术在听神经瘤治疗中的应用进展[J]. 中华耳科学杂志, 2020, 18(1): 25-32. DONG Yaodong, WEI Wei, MA Xiulan. Progress in Application of Stereotactic Radiosurgery in Treatment of Acoustic Neuroma [J]. Chinese Journal of Otology, 2020, 18(1): 25-32.
[13] Soliman H, Das S, Larson DA, et al. Stereotactic radiosurgery(SRS)in the modern management of patients with brain metastase s[J]. Oncotarget, 2016, 7(11): 12318-2330.
[14] Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy(QUARTZ): results from a phase 3, non-inferiority, randomised trial [J]. Lancet, 2016, 388(10055): 2004-2014.
[15] Gong X, Zhou D, Liang S, et al. Analyses of prognostic factors in cases of non-small cell lung cancer with multiple brain metastases [J]. Onco Targets Ther, 2016, 9: 977-983. doi: 10.2147/OTT.S94524.
[16] Fulop T, Kotb R, Fortin CF, et al. Potential role of immunosenescence in cancer development [J]. Ann N Y Acad Sci, 2010, 197: 158-165. doi: 10.1111/j.1749-6632.2009.05370.x.
[17] Gu Y, Zhang J, Zhou Z, et al. Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study [J]. Aging Dis, 2020, 11(1): 82-92.
[18] Venuta F, Diso D, Onorati I, et al. Lung cancer in elderly patients [J]. J Thorac Dis, 2016,(Suppl 11): S908-S914.
[19] 祁艺, 王宏伟, 张国荣. 伽玛刀治疗肺癌脑转移瘤的疗效及影响生存时间和预后的相关因素分析[J]. 脑与神经疾病杂志, 2016, 24(11): 709-713. QI Yi, WANG Hongwei, ZHANG Guorong. The curative effect, survival time and prognostic analysis for brain metastasis from lung cancer after Gamma-knife treatment [J]. Journal of Brain and Nervous Diseases, 2016, 24(11): 709-713.
[20] Weltman E, Salvajoli JV, Brandt RA, et al. Radiosurgery for brain metastases: a score index for predicting prognosis [J]. Int J Radiat Oncol Biol Phys, 2000, 46(5): 1155-1161.
[21] Zabel A, Milker-Zabel S, Thilmann C, et al. Treatment of brain metastases in patients with non-small cell lung cancer(NSCLC)by stereotactic linac-based radiosurgery: prognostic factors [J]. Lung Cancer, 2002, 37(1): 87-94.
[22] Routman DM, Bian SX, Diao K, et al. The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery [J]. Cancer Med, 2018, 7(3): 757-764.
[23] Chang WS, Kim HY, Chang JW, et al. Analysis of radiosurgical results in patients with brain metastases according to the number of brain lesions: is stereotactic radiosurgery effective for multiple brain metastases? [J]. J Neurosurg, 2010, 113 Suppl: 73-78. doi: 10.3171/2010.8.GKS10994.
[24] Likhacheva A, Pinnix CC, Parikh NR, et al. Predictors of Survival in Contemporary Practice After Initial Radiosurgery for Brain Metastases [J]. Int J Radiat Oncol Biol Phys, 2013, 85(3): 656-661.
[25] Cho KR, Lee MH, Kong DS, et al. Outcome of gamma knife radiosurgery for metastatic brain tumors derived from non-small cell lung cancer [J]. J Neurooncol, 2015, 125(2): 331-338.
[26] Bowden GN, Kim JO, Faramand A, et al. Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases [J]. J Neurosurg, 2020, 134(5): 1430-1434.
[27] Redmond KJ, Gui C, Benedict S, et al. Tumor Control Probability of Radiosurgery and Fractionated Stereotactic Radiosurgery for Brain Metastases [J]. Int J Radiat Oncol Biol Phys, 2021, 110(1): 53-67.

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