小细胞肺癌脑预防性放疗后发生脑转移的高危因素分析

发布时间：2018-02-24 10:42

本文关键词： 小细胞肺癌 TNM分期系统脑预防性放疗脑转移　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨小细胞肺癌(small cell lung cancer,SCLC)患者经脑预防性放疗(prophylactic cranial irradiation,PCI)后发生脑转移的高危因素。材料和方法:收集2010年5月至2016年5月在吉林大学白求恩第一医院有明确病理证实的SCLC患者99例,入组的所有患者均进行4~6周期EP或EC方案化疗并行胸部放疗,胸部放疗后1个月左右行脑预防性放疗。入组的99例患者中,32例发生脑转移,67例未发生脑转移,中位脑转移发生时间为24.05个月。入组的99例患者中有9例失访(其中脑转移组3例、对照组6例),随访率90.9%,中位随访时间23.0个月。按照脑转移发生与否,患者被分为脑转移组(试验组)及对照组。对两组间初诊时肿瘤TNM分期、性别、年龄和PCI剂量等因素进行统计学分析。主要采用单因素分析及多因素分析。单因素分析采用配对t检验、卡方检验及秩和检验;对于单因素分析中具有统计学差异的结果,进一步进行Logistic回归多因素分析。结果:2组间单因素分析结果提示:(1)T_(1-2)的SCLC患者发生脑转移3例,发生率为10.7%,T_3的为32.0%,T_4的为61.9%,经比较不同T分期患者的脑转移发生率差异有统计学意义(P=0.001);N_(0-1)的患者脑转移的发生率为6.45%,N_(2-3)的为44.1%,N分期高的患者脑转移发生率非常明显高于N分期低的患者(P0.001);(2)病程中发生其他组织脏器转移、肺部病灶控制不佳的患者脑预防性放疗后脑转移率高于未发生其他组织脏器转移及肺部病灶稳定的患者,差异有统计学意义(P0.05);(3)SCLC男性患者PCI后脑转移的发生率为41.2%,女性患者为12.9%,男性明显高于女性(P=0.005);(4)PCI后发生脑转移组,PCI中位剂量为25.3±1.23 Gy,对照组为26.5±3.01 Gy,两组差异有统计学意义(P=0.023)。多因素分析结果提示:(1)对于肿瘤TNM分期因素,T分期越高,发生脑转移的风险越大,OR值为3.648,95%CI为1.491~8.928;N分期越高,发生脑转移的风险越大,N分期为2~3期者脑转移的风险是0~1期的10.6倍,95%CI为2.502~44.535;(2)病程中发生其他组织脏器转移的患者,PCI后脑转移发生率更高,OR值为4.873,95%CI为1.218~19.492;肺部病灶控制不佳者,PCI后脑转移发生率更高,OR值为3.983,95%CI为1.092~14.526;(3)对于性别因素,SCLC男性患者PCI后发生脑转移的风险是女性的4.545倍,95%CI为1.233~16.667;(4)对于PCI剂量因素,PCI剂量越大,发生脑转移的风险越小,OR值为0.855,95%CI为0.739~0.988。结论:SCLC患者初诊T、N分期高、病程中发生其他组织脏器转移、肺部病灶控制不佳为PCI后脑转移发生的独立影响因素,男性患者有更高的PCI后脑转移发生率,而略高于常规的PCI剂量,即PCI剂量的提高或可减少颅内失败的几率、改善患者预后。但仍需进一步大样本量研究给予证实。
[Abstract]:Objective: to investigate the risk factors of brain metastasis in patients with small cell lung cancer (SCLC) after prophylactic cranial radiation therapy. Materials and methods: collected from May 2010 to May 2016 in Bai Qiuen first Hospital of Jilin University. 99 cases of pathologically proved SCLC, All the patients were treated with 4 cycles of EP or EC regimen chemotherapy and chest radiotherapy. Brain preventive radiotherapy was performed about 1 month after chest radiotherapy. Of the 99 patients, 32 had brain metastases and 67 had no brain metastases. The median time of brain metastasis was 24.05 months. There were 9 cases of brain metastasis (3 cases in brain metastasis group and 6 cases in control group). The follow-up rate was 90.9 and the median follow-up time was 23.0 months. The patients were divided into two groups: brain metastasis group (experimental group) and control group. The TNM stage, sex, and sex of tumor at first visit between the two groups, Age and PCI dose were statistically analyzed. Single factor analysis and multivariate analysis were used. Single factor analysis was performed by paired t test, chi-square test and rank sum test. Logistic regression multivariate analysis was carried out further. Results the results of univariate analysis between two groups suggested that brain metastases occurred in 3 patients with SCLC. The incidence of brain metastasis in patients with 10. 7 and 10. 7% of T _ 3 was 32.0 / T _ T _ 4, and 61.9 in patients with different T stages. The incidence of brain metastases in patients with different T stages was significantly higher than that in patients with high staging of 44.1 N and 6.45% of brain metastases in patients with different T stages were significantly higher than those in patients with high staging of 44.1 N. Other organ metastasis occurred in patients with low N stage (P 0.001). The rate of brain metastasis after brain preventive radiotherapy in patients with poor control of pulmonary lesions was higher than that in patients without other tissue metastasis and stable pulmonary lesions. The incidence of brain metastasis after PCI was 41.2 in male patients and 12.9 in female patients. The median dose of brain metastases was 25.3 卤1.23 Gy in patients with cerebral metastasis and 26.5 卤3.01 Gy in control group, which was significantly higher in men than in women. The results of multivariate analysis showed that the higher the T stage of TNM, the higher the T stage of tumor. The higher the risk of brain metastasis is, the higher the OR value is 3.648 卤95CI = 1.491and 8.928N, the higher the OR is, the higher the OR is, the higher the OR is, the higher the odds ratio is. The higher the risk of brain metastasis is, the higher the risk of brain metastasis in patients with stage 2 or 3 is 10.6 times than that in stage 0. 95 CI is 2.502n 44.535%) the incidence of brain metastasis after PCI is higher than that in patients with other organ metastasis after PCI, and the OR value is 4.8739 95 CI is 1.21818 and 19.492respectively, and the risk of brain metastasis in patients with brain metastasis is 10.6 times higher than that in stage 0 and stage 1. The risk of brain metastasis after PCI is higher than that in patients with other organ metastasis. The incidence of brain metastases after PCI was higher in poor patients than in women. The OR value was 3.9839.95 CI was 1.092 卤14.526) the risk of brain metastasis after PCI in male patients with PCI was 4.545 times than that in women (95 CI was 1.233 卤16.667C). The higher the dose of PCI was, the higher the risk of brain metastasis was. The lower the risk of brain metastasis is, the lower the OR value is 0.855 卤9595. The CI is 0.7390.998.Conclusion the patients with PCI have higher staging of Twouldn N and other organ metastasis in the course of the disease, and poor control of pulmonary lesions is the independent influencing factor of brain metastasis after PCI. Male patients have a higher incidence of brain metastasis after PCI, but slightly higher than the conventional PCI dose, that is, the increase of PCI dose may reduce the probability of intracranial failure and improve the prognosis of the patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

【相似文献】