在靶向治疗时代背景下：评估不同局部治疗方式对非小细胞肺癌1-3个脑转移瘤患者的生存获益情况。

In the context of the era of targeted therapy: evaluation of the survival benefits of different local treatment modalities for patients with 1-3 brain metastases from non-small cell lung cancer.

作者信息

Sun Liang, Chen Haibin, Yang Zhi, Li Liwen, Ying Zhaohui, Qu Yuanyuan, Tong Nanyang, Sun Caixing, Xia Liang

机构信息

Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), No. 1, East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China.

Department of Neurosurgery, Institute of Basic Medicine and Cancer (IBMC), Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang Province, People's Republic of China.

出版信息

Sci Rep. 2025 Jul 11;15(1):25067. doi: 10.1038/s41598-025-10042-w.

DOI:10.1038/s41598-025-10042-w

PMID:40646039

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12254283/

Abstract

Advances in molecular biology have extended survival for lung cancer patients with brain metastases. However, radiotherapy and surgery remain standard for non-small cell lung cancer (NSCLC) brain metastases. Existing studies assess surgical and radiotherapeutic outcomes using outdated data and lack relevant subgroup analyses. We retrospectively analyzed 298 NSCLC patients with 1-3 brain metastases. Overall survival (OS) and median OS were compared across five treatments: surgery + postoperative radiotherapy, surgery + postoperative non-radiotherapy, whole brain radiotherapy, stereotactic radiosurgery (SRS), and whole brain radiotherapy + SRS. Univariate and multivariate Cox regression analyses were conducted. Significant survival differences were noted among treatments (p = 0.0041) for patients with 1-3 brain metastases, single metastasis (p = 0.0034), age > 57 (p = 0.0001), wild-type EGFR/ALK (p = 0.0017), KPS ≥ 90 (p = 0.0379), tumor diameter ≤ 2.7 cm (p = 0.0147), and no extracranial metastasis (p = 0.0014). Surgery + postoperative radiotherapy and SRS significantly improved OS and median OS. For KPS ≥ 90, surgery + postoperative radiotherapy improved OS. Multivariate analysis identified age ≤ 57 (HR: 1.89; p < 0.001), surgery + postoperative radiotherapy (HR: 0.60; p = 0.017), and SRS (HR: 0.57; p = 0.01) as independent protective factors for OS. Surgery + postoperative radiotherapy and SRS enhance survival in NSCLC patients with 1-3 brain metastases, particularly those with wild-type EGFR/ALK, small metastases, and no extracranial metastases. For KPS ≥ 90, surgery followed by radiotherapy is recommended. SRS improves median OS in patients with KPS ≤ 80.

摘要

分子生物学的进展延长了脑转移肺癌患者的生存期。然而，放疗和手术仍然是非小细胞肺癌（NSCLC）脑转移的标准治疗方法。现有研究使用过时的数据评估手术和放射治疗的结果，并且缺乏相关的亚组分析。我们回顾性分析了298例有1-3个脑转移灶的NSCLC患者。比较了五种治疗方法的总生存期（OS）和中位OS：手术+术后放疗、手术+术后非放疗、全脑放疗、立体定向放射外科（SRS）以及全脑放疗+SRS。进行了单因素和多因素Cox回归分析。对于有1-3个脑转移灶的患者、单个转移灶患者（p = 0.0034）、年龄>57岁的患者（p = 0.0001）、野生型EGFR/ALK患者（p = 0.0017）、KPS≥90的患者（p = 0.0379）、肿瘤直径≤2.7 cm的患者（p = 0.0147）以及无颅外转移的患者（p = 0.0014），各治疗组之间的生存差异显著（p = 0.0041）。手术+术后放疗和SRS显著改善了OS和中位OS。对于KPS≥90的患者，手术+术后放疗改善了OS。多因素分析确定年龄≤57岁（HR：1.89；p < 0.001）、手术+术后放疗（HR：0.60；p = 0.017）和SRS（HR：0.57；p = 0.01）是OS的独立保护因素。手术+术后放疗和SRS可提高有1-3个脑转移灶的NSCLC患者的生存率，尤其是那些野生型EGFR/ALK、转移灶小且无颅外转移的患者。对于KPS≥90的患者，建议手术后继以放疗。SRS可改善KPS≤80患者的中位OS。