非小细胞肺癌脑膜转移的治疗及预后分析

摘要

Objective To analyze the treatment and prognosis of non-small cell lung cancer (NSCLC) with leptomeningeal metastases. Methods A retrospective analysis of 95 NSCLC patients with leptomeningeal metastases from May 2012 to October 2015 was reviewed. Patients received intravenous chemotherapy, whole brain radiation, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) or optimal support according to the baseline. The survival rate was calculated by Kaplan-Meier method and the single factor prognosis was analyzed with Log-rank method. The prognosis related multiple factor was analyzed by Cox proportional risk regression model. Results The median overall survival (OS) of the 95 patients was 6.4 months, and the 1-year survival rate was 6.3％. The median OS of 57 patients receiving whole brain radiation therapy was 8. 4 months, superior to 4.0 months of 38 patients who did not receive whole brain radiation (P＜0.001). The median OS of 40 patients receiving intravenous chemotherapy was 5.4 months, less than 7.5 months in 55 cases without chemotherapy (P = 0.010). The median OS of 49 patients receiving EGFR-TKIs treatment was 7.4 months, superior to 5.0 months in 46 patients who had not received EGFR-TKIs treatment. In addition, the longest median OS (9.4 months) was observed in 22 patients receiving whole brain radiation combined with EGFR-TKIs. ECOG score, whole brain radiation therapy and EGFR-TKIs were independent prognostic factors for NSCLC with leptomeningeal metastases. Conclusion Whole brain radiation therapy, EGFR-TKIs, especially combined therapy, could lead to better clinical prognosis for NSCLC patients with leptomeningeal metastases. EGFR-TKIs combined with whole brain radiotherapy are the most promising treatment plan.%目的 分析非小细胞肺癌(NSCLC)脑膜转移的治疗和预后情况.方法 回顾性分析2012年5月至2015年10月95例NSCLC脑膜转移患者的资料,根据患者基线情况给予静脉化疗、全脑放疗、表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKIs)或最佳支持治疗,采用Kaplan-Meier法计算生存率并用Log-rank法进行单因素预后分析,Cox比例风险回归模型进行多因素预后分析.结果 全组的中位生存期(OS)为6.4个月,1年生存率为6.3％.95例患者中,57例接受全脑放疗者的中位OS为8.4个月,优于38例未接受全脑放疗者的4.0个月(P＜0.001);40例接受静脉化疗者的中位OS为5.4个月,短于55例未接受静脉化疗者的7.5个月(P=0.010);49例接受EGFR-TKIs治疗者的中位OS为7.4个月,优于46例未接受EG-FR-TKIs治疗者的5.0个月(P = 0.05).此外,22例同时接受全脑放疗联合EGFR-TKIs者的中位OS最长,为9.4个月.ECOG体力评分、全脑放疗和EGFR-TKIs治疗是NSCLC脑膜转移的独立预后因素.结论 全脑放疗、EGFR-TKIs或两者联合应用可改善NSCLC脑膜转移患者的预后.EGFR-TKIs联合全脑放疗有望成为标准治疗方案.