肺腺癌脑膜转移患者生存情况及预后因素分析
发布时间：2018-09-18 15:37
【摘要】：目的和背景尸检研究显示非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移(brain metastases,BM)发病率为41%,脑膜转移(leptomeningeal metastases,LM)发病率为9%。NSCLC-LM最常见的病理类型为肺腺癌,占NSCLC的84-97%。LM是肺腺癌患者中枢神经系统(central nervous system,CNS)灾难性的并发症,生存期短,如不治疗,患者的中位生存期在4-6周之间。近年来肺腺癌治疗方面的进展尤其是表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)的应用和影像学诊断技术的进步,诊断为LM的病人数量越来越多。但由于血脑屏障(blood-brain barrier,BBB)的存在,抗肿瘤药物的脑脊液(cerebrospinal fluid,CSF)渗透性差,脑膜转移治疗效果有限,预后很差。肺腺癌脑膜转移治疗及预后方面的临床研究近年来逐渐增多。了解影响肺腺癌脑膜转移患者预后的相关因素,对我们更好的认知疾病、判断预后、合理选择治疗方案均有重大的指导意义。但目前影响肺腺癌脑膜转移患者预后的因素尚未完全确定。为探讨影响肺腺癌脑膜转移患者预后的相关因素,进一步为临床治疗决策的选择提供客观依据,我们对65例有完整随访资料的肺腺癌脑膜转移患者的临床资料进行了回顾性分析。方法回顾性收集2008年1月至2015年1月郑州大学人民医院肿瘤科收治的肺腺癌脑膜转移患者的临床资料并进行随访,对所有随访患者的资料建立数据库,资料完整者纳入本研究,采用SPSS21.0进行统计学分析,用Kaplan-Meier法进行生存分析,绘制生存曲线,使用Log-rank检验进行单因素分析,Cox回归模型进行多因素回归分析。结果65例肺腺癌脑膜转移患者中位生存时间为7.4个月,1年生存率为6.2%(4/65)。Log-rank单因素分析显示,性别、年龄、吸烟史、脑膜转移时间、是否合并脑转移与患者的总生存时间无显著相关(P值均0.05),而美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体力状况(performance status,PS)评分、是否接受脑室腹腔分流(Ventriculo-Peritoneal shunt,V-P分流)手术、EGFR-TKIs靶向治疗、全身化疗(Systemic chemotherapy,SC)、全脑放疗(Whole Brain Radiotherapy,WBRT)、脑膜转移时的临床症状和EGFR基因状态与患者的总生存时间显著相关(P值均0.05)。多因素回归分析显示,EGFR基因状态、ECOG PS评分、SC、V-P分流手术与否是肺腺癌脑膜转移患者患者独立的预后因素(P值均0.05)结论肺腺癌脑膜转移整体预后差,EGFR基因突变的脑膜患者预后相对较好。EGFR-TKIs靶向治疗、全身化疗和脑室腹腔分流手术有助于延长肺腺癌脑膜转移患者的生存时间,改善其预后。
[Abstract]:Objective and Background Autopsy studies have shown that the incidence of brain metastases (BM) and leptomeningeal metastases (LM) in non-small cell lung cancer (NSCLC) is 41% and 9%. The most common pathological type of NSCLC-LM is lung adenocarcinoma, accounting for 84-97% of NSCLC. LM is the central nervous system (CNS) in patients with lung adenocarcinoma. Recent advances in the treatment of lung adenocarcinoma, especially the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and advances in imaging diagnostic techniques, have led to an increasing number of patients diagnosed with LM. Because of the existence of blood-brain barrier (BBB), the cerebrospinal fluid (CSF) permeability of antineoplastic drugs is poor, the therapeutic effect of meningeal metastasis is limited, and the prognosis is poor. However, the factors affecting the prognosis of patients with meningeal metastasis of lung adenocarcinoma have not yet been fully determined. Methods The clinical data of 65 patients with meningeal metastasis from lung adenocarcinoma were retrospectively analyzed from January 2008 to January 2015 in the Department of Oncology, People's Hospital of Zhengzhou University. Data were analyzed by SPSS21.0, survival curves were plotted by Kaplan-Meier method, univariate analysis by Log-rank test and multivariate regression analysis by Cox regression model. Results The median survival time of 65 patients with meningeal metastasis of lung adenocarcinoma was 7.4 months, and the one-year survival rate was 6.2% (4%). Log-rank univariate analysis showed that gender, age, smoking history, time of meningeal metastasis, and whether or not combined with brain metastasis were not significantly associated with overall survival time (P 0.05), while the Eastern Cooperative Oncology Group (ECOG) score of physical status (PS), whether to accept ventriculoperitoneal shunt (VPS) or not. Ventriculo-Peritoneal shunt (V-P shunt), EGFR-TKIs targeted therapy, systemic chemotherapy (SC), Whole Brain Radiotherapy (WBRT), clinical symptoms during meningeal metastasis and EGFR gene status were significantly correlated with overall survival time (P 0.05). Multivariate regression analysis showed that EGFR gene status, EC gene status, and EC gene status were significantly correlated. OG PS score, SC, V-P shunt surgery or not are independent prognostic factors in patients with meningeal metastasis of lung adenocarcinoma (P 0.05). Conclusion The overall prognosis of meningeal metastasis of lung adenocarcinoma is poor, and the prognosis of meningeal patients with EGFR gene mutation is relatively good. EGFR-TKIs targeted therapy, systemic chemotherapy and ventriculoperitoneal shunt surgery are helpful to prolong the prognosis of meningeal metastasis of lung adenocarcinoma. The survival time of the patients improved their prognosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2248353
[Abstract]:Objective and Background Autopsy studies have shown that the incidence of brain metastases (BM) and leptomeningeal metastases (LM) in non-small cell lung cancer (NSCLC) is 41% and 9%. The most common pathological type of NSCLC-LM is lung adenocarcinoma, accounting for 84-97% of NSCLC. LM is the central nervous system (CNS) in patients with lung adenocarcinoma. Recent advances in the treatment of lung adenocarcinoma, especially the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and advances in imaging diagnostic techniques, have led to an increasing number of patients diagnosed with LM. Because of the existence of blood-brain barrier (BBB), the cerebrospinal fluid (CSF) permeability of antineoplastic drugs is poor, the therapeutic effect of meningeal metastasis is limited, and the prognosis is poor. However, the factors affecting the prognosis of patients with meningeal metastasis of lung adenocarcinoma have not yet been fully determined. Methods The clinical data of 65 patients with meningeal metastasis from lung adenocarcinoma were retrospectively analyzed from January 2008 to January 2015 in the Department of Oncology, People's Hospital of Zhengzhou University. Data were analyzed by SPSS21.0, survival curves were plotted by Kaplan-Meier method, univariate analysis by Log-rank test and multivariate regression analysis by Cox regression model. Results The median survival time of 65 patients with meningeal metastasis of lung adenocarcinoma was 7.4 months, and the one-year survival rate was 6.2% (4%). Log-rank univariate analysis showed that gender, age, smoking history, time of meningeal metastasis, and whether or not combined with brain metastasis were not significantly associated with overall survival time (P 0.05), while the Eastern Cooperative Oncology Group (ECOG) score of physical status (PS), whether to accept ventriculoperitoneal shunt (VPS) or not. Ventriculo-Peritoneal shunt (V-P shunt), EGFR-TKIs targeted therapy, systemic chemotherapy (SC), Whole Brain Radiotherapy (WBRT), clinical symptoms during meningeal metastasis and EGFR gene status were significantly correlated with overall survival time (P 0.05). Multivariate regression analysis showed that EGFR gene status, EC gene status, and EC gene status were significantly correlated. OG PS score, SC, V-P shunt surgery or not are independent prognostic factors in patients with meningeal metastasis of lung adenocarcinoma (P 0.05). Conclusion The overall prognosis of meningeal metastasis of lung adenocarcinoma is poor, and the prognosis of meningeal patients with EGFR gene mutation is relatively good. EGFR-TKIs targeted therapy, systemic chemotherapy and ventriculoperitoneal shunt surgery are helpful to prolong the prognosis of meningeal metastasis of lung adenocarcinoma. The survival time of the patients improved their prognosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
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