Aoki Shuri, Kanda Tomonori, Matsutani Noriyuki, Seki Nobuhiko, Kawamura Masafumi, Furui Shigeru, Yamashita Hideomi
Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo 173-8605, Japan.
Department of Radiology, University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan.
Oncol Lett. 2017 Jul;14(1):1073-1079. doi: 10.3892/ol.2017.6264. Epub 2017 May 26.
Previous studies have been conducted on the prognostic factors for overall survival in patients with brain metastases (BMs) following whole brain radiotherapy (WBRT). However, there have been a small number of studies regarding the prognostic factors for the response of tumor to WBRT. The aim of the present study was to identify the predictive factors for the response to WBRT from the point of view of reduction of tumor using magnetic resonance imaging. A retrospective analysis of 62 patients with BMs from primary lung cancer treated with WBRT was undertaken. The effects of the following factors on the response to WBRT were evaluated: Age; sex; performance status; lactate dehydrogenase; pathology; existence of extracranial metastases; activity of extracranial disease; chemo-history; chest radiotherapy history; treatment term; γ-knife radiotherapy; diffusion weighted image signal intensity; tumor diameter; extent of edema and the edema/tumor (E/T) ratio. The association between the reduction of tumors and clinical factors was evaluated using logistic regression analysis. P<0.05 was considered to indicate a statistically significant difference. The overall response ratio of this cohort was 54.8%. In the univariate analysis, the response of tumors was associated with the presence of small cell lung carcinoma (SCLC; P=0.0007), an E/T ratio of ≥1.5 (P=0.048), and a median tumor diameter of <20 mm (P=0.014). In the multivariate analysis, the presence of SCLC [P=0.001; odds ratio (OR), 17.152), an E/T ratio of ≥1.5 (P=0.019; OR, 9.526), and the presence of extracranial metastases (P=0.031; OR, 4.875) were revealed to be independent predictive factors for the reduction of tumor. The following 3 factors were significantly associated with the response of tumors to WBRT: The presence of SCLC; an E/T ratio of ≥1.5; and the presence of extracranial metastases. The E/T ratio is a novel index that provides a simple and easy predictive method for use in a clinical setting.
此前已有研究针对全脑放疗（WBRT）后发生脑转移（BMs）患者的总生存预后因素展开。然而，关于肿瘤对WBRT反应的预后因素的研究却为数不多。本研究的目的是从利用磁共振成像评估肿瘤缩小的角度，确定WBRT反应的预测因素。对62例接受WBRT治疗的原发性肺癌脑转移患者进行了回顾性分析。评估了以下因素对WBRT反应的影响：年龄；性别；体能状态；乳酸脱氢酶；病理；颅外转移的存在情况；颅外疾病的活动情况；化疗史；胸部放疗史；治疗期限；伽玛刀放疗；扩散加权图像信号强度；肿瘤直径；水肿范围以及水肿/肿瘤（E/T）比值。使用逻辑回归分析评估肿瘤缩小与临床因素之间的关联。P<0.05被认为具有统计学显著差异。该队列的总体反应率为54.8%。在单因素分析中，肿瘤反应与小细胞肺癌（SCLC）的存在（P=0.0007）、E/T比值≥1.5（P=0.048）以及肿瘤中位直径<20 mm（P=0.014）相关。在多因素分析中，SCLC的存在[P=0.001；比值比（OR），17.152]、E/T比值≥1.5（P=0.019；OR，9.526）以及颅外转移的存在（P=0.031；OR，4.875）被揭示为肿瘤缩小的独立预测因素。以下3个因素与肿瘤对WBRT的反应显著相关：SCLC的存在；E/T比值≥1.5；以及颅外转移的存在。E/T比值是一种新的指标，为临床应用提供了一种简单易行的预测方法。
