Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):330-7. doi: 10.1016/j.ijrobp.2014.02.025. Epub 2014 Apr 8.
We intended to identify risk factors that affect brain metastases (BM) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiation therapy, which may guide the choice of selective prevention strategies.
The characteristics of 346 patients with stage III NSCLC treated with thoracic radiation therapy from January 2008 to December 2010 in our institution were retrospectively reviewed. BM rates were analyzed by the Kaplan-Meier method. Multivariate Cox regression analysis was performed to determine independent risk factors for BM.
The median follow-up time was 48.3 months in surviving patients. A total of 74 patients (21.4%) experienced BM at the time of analysis, and for 40 (11.7%) of them, the brain was the first site of failure. The 1-year and 3-year brain metastasis rates were 15% and 28.1%, respectively. In univariate analysis, female sex, age ≤60 years, non-squamous cell carcinoma, T3-4, N3, >3 areas of lymph node metastasis, high lactate dehydrogenase and serum levels of tumor markers (CEA, NSE, CA125) before treatment were significantly associated with BM (P<.05). In multivariate analysis, age ≤60 years (P=.004, hazard ratio [HR] = 0.491), non-squamous cell carcinoma (P=.000, HR=3.726), NSE >18 ng/mL (P=.008, HR=1.968) and CA125 ≥ 35 U/mL (P=.002, HR=2.129) were independent risk factors for BM. For patients with 0, 1, 2, and 3 to 4 risk factors, the 3-year BM rates were 7.3%, 18.9%, 35.8%, and 70.3%, respectively (P<.001).
Age ≤60 years, non-squamous cell carcinoma, serum NSE >18 ng/mL, and CA125 ≥ 35 U/mL were independent risk factors for brain metastasis. The possibilities of selectively using prophylactic cranial irradiation in higher-risk patients with LA-NSCLC should be further explored in the future.
我们旨在确定影响接受根治性放射治疗的局部晚期非小细胞肺癌（LA-NSCLC）患者脑转移（BM）的风险因素，这可能有助于指导选择性预防策略的选择。
回顾性分析了 2008 年 1 月至 2010 年 12 月我院 346 例 III 期 NSCLC 患者的胸部放疗特征。采用 Kaplan-Meier 法分析 BM 发生率。采用多变量 Cox 回归分析确定 BM 的独立危险因素。
存活患者的中位随访时间为 48.3 个月。在分析时，共有 74 例（21.4%）患者发生 BM，其中 40 例（11.7%）患者脑是首发失败部位。1 年和 3 年的脑转移率分别为 15%和 28.1%。单因素分析显示，女性、年龄≤60 岁、非鳞状细胞癌、T3-4、N3、>3 个淋巴结转移区、乳酸脱氢酶和肿瘤标志物（CEA、NSE、CA125）水平升高与 BM 显著相关（P<.05）。多因素分析显示，年龄≤60 岁（P=.004，风险比[HR] = 0.491）、非鳞状细胞癌（P=.000，HR=3.726）、NSE >18 ng/mL（P=.008，HR=1.968）和 CA125≥35 U/mL（P=.002，HR=2.129）是 BM 的独立危险因素。对于 0、1、2 和 3-4 个危险因素的患者，3 年 BM 发生率分别为 7.3%、18.9%、35.8%和 70.3%（P<.001）。
年龄≤60 岁、非鳞状细胞癌、血清 NSE >18 ng/mL 和 CA125≥35 U/mL 是非小细胞肺癌脑转移的独立危险因素。在未来，应进一步探讨在 LA-NSCLC 高危患者中选择性使用预防性颅脑照射的可能性。
