肿瘤组织学预测了肺癌脑转移患者接受伽玛刀放射外科治疗后的失败模式和生存情况。
Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery.
机构信息
Departments of ‡Radiation Oncology; §Internal Medicine, Hematology, and Oncology; ¶Neurosurgery, and ‖Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina; †Deceased.
出版信息
Neurosurgery. 2013 Oct;73(4):641-7; discussion 647. doi: 10.1227/NEU.0000000000000072.
BACKGROUND
We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS).
OBJECTIVE
To determine whether tumor histology predicts patient outcomes.
METHODS
Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy.
RESULTS
Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P < .0121).
CONCLUSION
Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.
背景
我们回顾了经伽玛刀放射外科治疗初诊脑转移肺癌患者的经验。
目的
确定肿瘤组织学是否可预测患者预后。
方法
在我们机构，2000 年 7 月 1 日至 2010 年 12 月 31 日期间，对 271 例原发性肺癌脑转移患者采用伽玛刀放射外科治疗。我们的研究包括 44 例鳞状细胞癌（SCC）、31 例小细胞癌（SCLC）和 138 例腺癌（ACA）患者；47 例因病理不足而无法确定亚型的患者被排除在外。非小细胞肺癌（NSCLC）患者在接受伽玛刀放射外科治疗前均未接受全脑放疗（WBRT），SCLC 患者允许预防性颅脑照射，但不得有已知脑转移。中位 2 个病灶/患者，中位边缘剂量为 20 Gy。
结果
ACA、SCLC 和 SCC 患者的中位生存期分别为 10.2 个月、5.9 个月和 5.3 个月（P=0.008）。ACA、SCC 和 SCLC 的 1 年局部控制率分别为 86%、86%和 54%（P=0.027）。ACA、SCC 和 SCLC 的 1 年远处失败率分别为 35%、63%和 65%（P=0.057）。ACA、SCC 和 SCLC 患者死于神经源性死亡的可能性分别为 29%、36%和 55%（P=0.027）。SCC 患者的中位 WBRT 时间为 11 个月，而 ACA 患者为 24 个月（P=0.04）。多变量分析证实 SCLC 组织学是局部控制（风险比[HR]：6.46，P=0.025）和远处失败（HR：3.32，P=0.0027）恶化的显著预测因素。对于 NSCLC 组织学，SCC 预测 WBRT 挽救性治疗的时间更早（HR：2.552，P=0.01）和总体生存更差（HR：1.77，P < 0.0121）。
结论
肺癌的组织学亚型似乎可预测预后。未来的试验和预后指数应考虑这些组织学特异性模式。
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