Iwasaki Akinori, Shirakusa Takayuki, Yoshinaga Yasuteru, Enatsu Sotarou, Yamamoto Masaaki
Second Department of Surgery, School of Medicine, Fukuoka University, 45-1, 7-chome Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Eur J Cardiothorac Surg. 2004 Sep;26(3):488-93. doi: 10.1016/j.ejcts.2004.05.049.
The modality of treatment for patients with brain metastasis from non-small cell lung cancer (NSCLC) has not yet been established. Among these patients, few survive longer than 3 years. However, a small group of these patients demonstrate a better prognosis. The objective of this study is to clarify the efficacy of treatment and evaluate factors affecting long-term patient survival.
We retrospectively reviewed the medical charts of 70 patients found to have brain metastasis from NSCLC in Fukuoka University Hospital between 1994 and 2002. These patients were grouped according to therapy received for the brain and lung and separated into two groups, as follows: LBR, lung and brain resection; LR, lung resection without brain resection. We also evaluated these groups for a set of several factors. Risk score was calculated with reference to the data from multivariate analysis, which can estimate survival.
The number of patients who underwent lung surgery plus brain surgery was 41. In this LBR, the 1- and 3-year survival rates after treatment of brain were 66.4 and 22.9%, respectively. We found that a therapeutic strategy including surgery for primary lung and brain can afford patients an extended survival time compared to the survivals of other LR group. The 3-year survival of patients with high carcinoembryonic antigen (CEA) was 0 vs. 39.6% among patients normal for CEA. Some factors, including histological type, nodal metastasis, serum LDH and CEA, were associated with survival. The multivariate Cox model identified both adenocarcinoma histological subtype, node status and high serum CEA as independent prognostic factors, whereas serum LDH was not found to be significant. Risk score was determined in our study to estimate prognosis according to the multivariate data. From this equation, previously we can expect 1- or 3-year survival of each patient with brain metastasis from NSCLC, refer to the risk score.
Stringent selection, i.e. low-risk score (adenocarcinoma, node-negative and normal level of CEA) of candidates for surgical treatment for primary lung and brain metastasis from NSCLC may be an acceptable and valuable approach.
非小细胞肺癌（NSCLC）脑转移患者的治疗方式尚未确定。在这些患者中，很少有人能存活超过3年。然而，一小部分此类患者预后较好。本研究的目的是阐明治疗效果并评估影响患者长期生存的因素。
我们回顾性分析了1994年至2002年期间在福冈大学医院确诊为NSCLC脑转移的70例患者的病历。这些患者根据针对脑和肺接受的治疗进行分组，分为以下两组：LBR组，肺和脑切除；LR组，仅肺切除未进行脑切除。我们还评估了这些组的一系列因素。参照多因素分析的数据计算风险评分，该评分可用于估计生存率。
接受肺手术加脑手术的患者有41例。在这个LBR组中，脑转移治疗后的1年和3年生存率分别为66.4%和22.9%。我们发现，与其他LR组的生存率相比，包括对原发性肺和脑进行手术的治疗策略可以为患者延长生存时间。癌胚抗原（CEA）高的患者3年生存率为0，而CEA正常的患者为39.6%。包括组织学类型、淋巴结转移、血清乳酸脱氢酶（LDH）和CEA在内的一些因素与生存相关。多因素Cox模型确定腺癌组织学亚型、淋巴结状态和高血清CEA均为独立的预后因素，而血清LDH未显示出显著性。在我们的研究中确定了风险评分，以便根据多因素数据估计预后。根据这个公式，以前我们可以根据风险评分预测每个NSCLC脑转移患者的1年或3年生存率。
对于NSCLC原发性肺和脑转移的手术治疗候选者进行严格筛选，即低风险评分（腺癌、淋巴结阴性且CEA水平正常）可能是一种可接受且有价值的方法。
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