吉非替尼治疗非小细胞肺癌脑转移的临床研究

摘要

目的:分析吉非替尼治疗非小细胞肺癌脑转移的疗效、生活质量、预后及其相关因素.方法:对40例资料完整的非小细胞肺癌脑转移患者的临床特点、治疗效果、生活质量及生存时间进行回顾性分析.所有患者发生脑转移后均口服吉非替尼250 mg/天,直到病变进展或发生不可耐受的不良反应.结果:吉非替尼治疗非小细胞肺癌脑转移的颅内病灶的疗效疾病控制率为83％,颅内病变疾病控制率与病理类型具有相关性.全身病变的疾病控制率为78％,全身病变疾病控制率与患者的病理类型、PS评分、脑转移数目(单发或多发)、服药后出现皮疹与否具有相关性(P＜0.05).全组患者中36例患者完成生活质量评价问卷,治疗8周后5种功能状态(躯体、角色、情感、认知、社会)和整体生活质量评分的均值显著增加,且差异均有显著性(P＜0.05)；2个全身症状(乏力、食欲不振)以及肺癌相关症状(呼吸困难、咳嗽、胸痛)评分的均值降低,其中乏力、呼吸困难、咳嗽的差异有显著性(P＜0.05).本组患者的中位TTP 6个月,TTP与患者的PS评分具有相关性(P=0.000)与服药后是否有皮疹具有相关性(P=0.016).中位生存期11个月,生存期与PS评分、服药后皮疹情况和脑转移数目具有相关性(P分别为0.000、0.000和0.016).不良反应可耐受,主要表现为轻度皮疹和腹泻.结论:吉非替尼治疗肺癌脑转移有效,可以改善患者预后,且不良反应轻微.%Objective: To evaluate the efficacy, quality of life and prognosis of gefitinib in NSCLC patients with brain metastases. Methods: The clinical characteristics, response to treatment and outcome of survival were retrospectively reviewed in forty NSCLC patients with brain metastasis. All patients were treated with gefitinib of 250mg. After diagnosed as brain metastasis. These patients discontinued administration of gefitinib when disease progression, or intolerable side effects appeared. Results: The disease controlled rate of gefitinib for brain lesions was 83% ,ade-nocarcinoma patients had better disease control rate. The overall disease controlled rate was 78% , the overall disease controlled rate was related to histology, patients'PS score, the number of brain metastases and skin rash. 36 patients finished the questionnaires, compared to the mean scores before treatment, the mean scores of five functional scales (physical,role,emotional cognitional and social) and the mean score of global QOL were improved. There were statistical differences in five functional scales and global QOL(P <0. 05 ). The mean scores of main general symptoms fatigue decreased, compared to which before treatment, and the mean scores of disease -related symptoms (coughing, pain in chest .dyspnoea) decreased after treatment. There were statistical differences in fatigue, dyspnoea and cough ( P < 0. 05 ). Median time to progression was 6 months , which was related to the patients' PS score (P = 0. 000) and the occurring of the skin rash( P = 0.016). The median overall survival time was 11 months. Which was related to the patients'PS score (P =0.000), the occurring of the skin rash(P =0.000) and the number of brain metastases(P = 0.016). Conclusion; Gefitinib is active and safe in patients with brain metastasis from NSCLC.