Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Chao yang District, Beijing, China.
Radiat Oncol. 2012 Jul 30;7:119. doi: 10.1186/1748-717X-7-119.
Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset.
Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan-Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM.
Fifty-three (24.4 %) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86-9.19; P = 0.001) and the ratio of metastatic to examined nodes or lymph node ratio (LNR) ≥ 30 % (RR: 3.33, 95 % CI: 1.79-6.18; P = 0.000) were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %.
In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.
脑转移（BM）是局部晚期非小细胞肺癌（LA-NSCLC）综合治疗后最常见的失败之一。预防性颅脑照射（PCI）试验的结果促使我们确定最有可能从 PCI 中获益的高危亚组。本研究聚焦完全切除的病理 IIIA-N2（pIIIA-N2）期非小细胞肺癌患者，旨在评估 BM 的危险因素，并确定高危亚组。
回顾性分析我院 2003 年至 2005 年间 217 例完全切除的 pIIIA-N2 期非小细胞肺癌患者的临床资料。采用 Kaplan-Meier 法估计 BM 的累积发生率，采用对数秩检验比较组间差异。采用多因素 Cox 回归分析评估 BM 的危险因素。
53 例（24.4%）患者在临床过程中出现 BM。多因素分析显示，非鳞癌（RR：4.13，95%CI：1.86-9.19；P=0.001）和转移淋巴结与检查淋巴结的比值（LNR）≥30%（RR：3.33，95%CI：1.79-6.18；P=0.000）与 BM 风险增加相关。非鳞癌且 LNR≥30%的患者，5 年 BM 累积发生率为 57.3%。
在 NSCLC 中，完全切除的 pIIIA-N2 期非鳞癌且 LNR≥30%的患者发生 BM 的风险最高，最有可能从 PCI 中获益。需要进一步研究来评估 PCI 对这部分患者的疗效。
