Yu Guizhi, Zhou Jianxi, Dai Junli, Lian Rui
Department of Radiation Oncology, Chengde Central Hospital, Chengde, Hebei 067000, P.R. China.
Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, Hebei 061000, P.R. China.
Oncol Lett. 2024 Jul 3;28(3):422. doi: 10.3892/ol.2024.14555. eCollection 2024 Sep.
Small cell lung cancer (SCLC) is an aggressive malignancy with a high propensity for brain metastases (BM). Limited-stage SCLC (LS-SCLC) can be effectively treated with chemoradiotherapy and prophylactic cranial irradiation (PCI) to enhance patient outcomes. The aim of the present study was to assess the risk factors and prognostic significance of brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) who attained complete remission (CR) or partial remission (PR) following combined chemoradiotherapy and subsequent prophylactic cranial irradiation (PCI). Data for 290 patients diagnosed with LS-SCLC and treated at Chengde Central Hospital and Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine (Chengde, China), who achieved CR or PR and underwent PCI between 2015 and 2023, were retrospectively analyzed. BM rates and overall survival (OS) were estimated using the Kaplan-Meier method, whilst differences were assessed using the log-rank test. Risk factors affecting BM and OS were assessed using univariate and multivariate Cox regression analyses. The overall incidence of BM after PCI was 16.6% (48/290), with annual rates of 1.4, 6.6 and 12.8% at 1, 2 and 3 years, respectively. Multivariate Cox regression analysis identified an initial tumor size of >5 cm [hazard ratio (HR)=15.031; 95% confidence interval (CI): 5.610-40.270; P<0.001] as a significant independent risk factor for BM following PCI. The median OS was 28.8 months and the 5-year OS rate was 27.9%. The median OS for patients with and without BM at 27.55 and 32.5 months, respectively, and the corresponding 5-year OS rates were 8.3 and 31.8%, respectively (P=0.001). Median OS rates for stages I, II and III were 61.15, 48.5 and 28.4 months, respectively, with 5-year OS rates of 62.5, 47.1 and 21.6%, respectively (P<0.001). Further multivariate Cox regression analysis indicated that BM (HR=1.934; 95% CI: 1.358-2.764; P<0.001) and clinical stage (HR=1.741; 95% CI: 1.102-2.750; P=0.018; P=0.022) were significant independent risk factors associated with patient OS. In conclusion, a tumor size of >5 cm is a significant risk factor for BM following PCI in patients with LS-SCLS achieving CR or PR through radiotherapy and chemotherapy. Furthermore, BM and clinical staging independently influence OS.
小细胞肺癌（SCLC）是一种侵袭性恶性肿瘤，极易发生脑转移（BM）。局限期小细胞肺癌（LS-SCLC）可通过放化疗及预防性颅脑照射（PCI）进行有效治疗，以改善患者预后。本研究旨在评估接受联合放化疗及后续预防性颅脑照射（PCI）后达到完全缓解（CR）或部分缓解（PR）的局限期小细胞肺癌（LS-SCLC）患者发生脑转移（BM）的危险因素及预后意义。对290例在承德市中心医院和河北沧州中西医结合医院（中国承德）诊断为LS-SCLC并接受治疗、于2015年至2023年间达到CR或PR且接受PCI的患者的数据进行回顾性分析。采用Kaplan-Meier法估计脑转移率和总生存期（OS），并使用对数秩检验评估差异。采用单因素和多因素Cox回归分析评估影响脑转移和总生存期的危险因素。PCI后脑转移的总发生率为16.6%（48/290），1年、2年和3年的年发生率分别为1.4%、6.6%和12.8%。多因素Cox回归分析确定初始肿瘤大小>5 cm[风险比（HR）=15.031；95%置信区间（CI）：5.610-40.270；P<0.001]是PCI后脑转移的显著独立危险因素。中位总生存期为28.8个月，5年总生存率为27.9%。有脑转移和无脑转移患者的中位总生存期分别为27.55个月和32.5个月，相应的5年总生存率分别为8.3%和31.8%（P=0.001）。I期、II期和III期的中位总生存期分别为61.15个月、48.5个月和28.4个月，5年总生存率分别为62.5%、47.1%和21.6%（P<0.001）。进一步的多因素Cox回归分析表明，脑转移（HR=1.934；95%CI：1.358-2.764；P<0.001）和临床分期（HR=1.741；95%CI：1.102-2.750；P=0.018；P=0.022）是与患者总生存期相关的显著独立危险因素。总之，肿瘤大小>5 cm是通过放化疗达到CR或PR的LS-SCLS患者PCI后脑转移的显著危险因素。此外，脑转移和临床分期独立影响总生存期。
