Bae Mi Kyung, Yu Woo Sik, Byun Go Eun, Lee Chang Young, Lee Jin Gu, Kim Dae Joon, Chung Kyung Young
Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang-si, Gyeonggi-do 410-719, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Lung Cancer. 2015 May;88(2):195-200. doi: 10.1016/j.lungcan.2015.02.013. Epub 2015 Feb 23.
This study aimed to determine prognostic factors associated with postrecurrence survival in cases with postoperative brain metastasis but with no extracranial metastasis in non-small cell lung cancer (NSCLC).
Between 1992 and 2012, a total of 2832 patients underwent surgical resection for NSCLC. Among those, 86 patients had postoperative brain metastasis as the initial recurrence. Those patients were retrospectively reviewed.
The median follow-up time after the initial lung resection was 24.0 months (range, 2.0-126.0 months). The median overall survival after initial lung cancer resection was 25.0 months and the median overall postrecurrence survival was 11 months. An initial lesion of adenocarcinoma (hazard ratio, 0.548; 95% confidence interval, 0.318 to 0.946; p=0.031), non-pneumonectomy, and a disease-free interval longer than 10.0 months (hazard ratio, 0.565; 95% confidence interval, 0.321-0.995; p=0.048) from the initial lung resection to the diagnosis of brain metastasis positively related to a good postrecurrence survival. Solitary brain metastasis and a size of less than 3 cm for the largest brain lesion were also positive factors for postrecurrence survival. Systemic chemotherapy for brain metastasis (hazard ratio, 0.356; 95% confidence interval, 0.189-0.670; p=0.001) and local treatment of surgery and/or stereotactic radiosurgery (SRS) for brain lesions (hazard ratio, 0.321; 95% confidence interval, 0.138-0.747; p=0.008) were positive factors for better postrecurrence survival.
In patients with brain metastasis after resection for NSCLC with no extracranial metastasis, adenocarcinoma histologic type, longer disease-free interval, systemic chemotherapy for brain metastasis and local treatment of surgery and/or SRS for brain metastasis are independent positive prognostic factors for postrecurrence survival.
本研究旨在确定非小细胞肺癌（NSCLC）术后脑转移但无颅外转移患者复发后生存的预后因素。
1992年至2012年间，共有2832例患者接受了NSCLC手术切除。其中，86例患者以术后脑转移作为初始复发。对这些患者进行回顾性分析。
初次肺切除术后的中位随访时间为24.0个月（范围2.0 - 126.0个月）。初次肺癌切除术后的中位总生存期为25.0个月，复发后的中位总生存期为11个月。腺癌初始病灶（风险比，0.548；95%置信区间，0.318至0.946；p = 0.031）、非肺叶切除术以及从初次肺切除到脑转移诊断的无病间期超过10.0个月（风险比，0.565；95%置信区间，0.321 - 0.995；p = 0.048）与复发后良好生存呈正相关。孤立性脑转移以及最大脑病灶大小小于3 cm也是复发后生存的积极因素。脑转移的全身化疗（风险比，0.356；95%置信区间，0.189 - 0.670；p = 0.001）以及脑病灶的手术和/或立体定向放射外科（SRS）局部治疗（风险比，0.321；95%置信区间，0.138 - 0.747；p = 0.008）是复发后生存更好的积极因素。
在无颅外转移的NSCLC切除术后发生脑转移的患者中，腺癌组织学类型、更长的无病间期、脑转移的全身化疗以及脑转移的手术和/或SRS局部治疗是复发后生存的独立积极预后因素。
