局限期小细胞肺癌放化疗后疗效与脑转移的关系探讨

摘要

目的：探讨局限期小细胞肺癌（ LD-SCLC）放化疗后疗效与脑转移的关系。方法：回顾性分析天津医科大学肿瘤医院放疗科2009年4月至2012年4月间行放化疗的149例LD-SCLC患者临床资料，放化疗后疗效评价根据RECIST标准分为完全缓解（CR）、部分缓解（PR）、病情稳定（SD）及疾病进展（PD），客观缓解包括CR和PR。生存分析采用Kaplan-Meier法并用Log-rank进行检验，χ2检验进行组间比较。结果：全组患者的中位生存时间（OS）为20.0个月，3年OS为33.0%。多因素分析发现，放化疗后疗效（P<0.001）及是否出现脑转移（P<0.001）是影响患者OS的重要因素。全组共43例（28.8%）出现脑转移，CR、PR、SD/PD患者分别有12例（29.3%）、9例（11.8%）、22例（68.8%）出现脑转移（P=0.027）。放化疗后疗效与无脑转移生存率（BMFS）之间差异具有统计学意义（P=0.005），CR、PR、SD及PD患者的2年BMFS分别为79.5%、71.9%、45.8%和49.6%。进一步分析发现，放化疗后达CR者，行脑预防性放疗（PCI）与未行PCI患者的生存率亦存在统计学差异（P=0.007）。结论：LD-SCLC患者放化疗后达CR者有较好的BMFS和较低的脑转移率，且行脑预防照射者OS亦优于未行脑预防者，建议放化疗后达CR患者，应尽快考虑脑预防放疗。%Objective:To determine the relationship between the curative effect of chemo radiotherapy and brain metastasis in limited-disease small cell lung cancer (LD-SCLC). Methods:Data of 149 patients with LD-SCLC who had undergone chemoradiother-apy between April 2009 and April 2012 were analyzed. The curative effect of chemoradiotherapy was evaluated using RECIST version 1.1, which includes complete response (CR), partial response (PR), stable disease (SD), and progression of disease (PD). The objective relief includes CR and PR. Survival was analyzed using Kaplan-Meier method.χ2 text was used to analyze the correlation between the factors. Results:The median overall survival (OS) was 20.0 months, and the 3-year OS rate was 33.0%. Brain metastasis occurred in 43 (28.8%) out of the 149 patients. Among the 43 cases, 12 (29.3%), 9 (11.8%), and 22 (68.8%) had CR, PR, and SD/PD, respectively (P=0.007). The curative effect of chemoradiotherapy correlates with the rate of brain metastasis (17.8%vs. 68.8%, P=0.027). Signifi-cant differences were found between the curative effect and the brain metastasis-free survival (BMFS) (P=0.005). The 2-year BMSF for CR patients was 79.5%, and the corresponding 2-year BMSF for PR, SD, and PD patients was 71.9%, 45.8%, and 49.6%, respectively. Further analysis showed that the performance of prophylactic cranial irradiation (PCI) had an important effect on the OS (P=0.007) of patients who achieved objective relief. Conclusion:The BMFS of patients with LD-SCLC who achieved CR after chemoradiotherapy is favorable, with low rate of brain metastasis. Patients who received PCI had a better OS. Thus, we suggest that timely PCI should be considered for the patients who achieved CR.