Zhang Qin, Cai Xu-Wei, Feng Wen, Yu Wen, Fu Xiao-Long
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Ann Transl Med. 2020 Mar;8(6):374. doi: 10.21037/atm.2020.02.72.
This study aimed to identify the risk factors of brain metastases (BM) as the initial site of failure in patients with completely resected stage IIIA (N2) non-small-cell lung cancer (NSCLC).
From January 2005 and June 2012, the clinical data of 357 patients with completely resected stage IIIA (N2) NSCLC were reviewed in this study. Kaplan-Meier analysis was used to identify the incidence of BM as the initial site of failure and survival. To assess the risk factors of BM, the log-rank test and Cox regression were used for univariate analysis and multivariate analysis, separately.
Seventy-three (20.4%) patients developed BM; 60 patients had BM as their initial site of failure. The 1-, 3-, and 5-year risk for patients developing BM as the initial site of failure was 9.1%, 27.4% and 35.4%, respectively. Univariate analysis showed adenocarcinoma histology (P=0.000), number of regional LN >4 (P=0.018), multiple N2 stations (P=0.027), multiple region of LN involvement (P=0.010) were significantly associated with an increased risk of developing BM as the initial site of failure. Multivariate analysis showed adenocarcinoma (P=0.001; HR =0.150; 95% CI, 0.047-0.479), multiple regions of LN involvement (P=0.015; HR =2.010; 95% CI, 1.146-3.524) were significantly associated with the high risk of developing BM as the initial site of failure. In patients with adenocarcinoma and multiple regions of LN involvement, the 5-year actuarial risk of BM as the initial failure was 47.6%, respectively.
Adenocarcinoma and multiple regions of LN involvement were independent risk factors for BM as the initial failure in completely resected stage IIIA (N2) NSCLC. Prospective clinical trials are needed to verify the effect of PCI in the highest-risk subset we identified.
本研究旨在确定完全切除的IIIA期（N2）非小细胞肺癌（NSCLC）患者中，脑转移（BM）作为初始失败部位的危险因素。
本研究回顾了2005年1月至2012年6月期间357例完全切除的IIIA期（N2）NSCLC患者的临床资料。采用Kaplan-Meier分析确定BM作为初始失败部位的发生率和生存率。为评估BM的危险因素，分别采用对数秩检验和Cox回归进行单因素分析和多因素分析。
73例（20.4%）患者发生了BM；60例患者以BM作为初始失败部位。患者发生BM作为初始失败部位的1年、3年和5年风险分别为9.1%、27.4%和35.4%。单因素分析显示腺癌组织学类型（P=0.000）、区域淋巴结数量>4个（P=0.018）、多个N2站（P=0.027）、多个淋巴结受累区域（P=0.010）与发生BM作为初始失败部位的风险增加显著相关。多因素分析显示腺癌（P=0.001；HR=0.150；95%CI，0.047-0.479）、多个淋巴结受累区域（P=0.015；HR=2.010；95%CI，1.146-3.524）与发生BM作为初始失败部位的高风险显著相关。在腺癌和多个淋巴结受累区域的患者中，BM作为初始失败的5年精算风险分别为47.6%。
腺癌和多个淋巴结受累区域是完全切除的IIIA期（N2）NSCLC患者中BM作为初始失败的独立危险因素。需要进行前瞻性临床试验来验证预防性颅脑照射（PCI）对我们所确定的最高风险亚组的疗效。
