發(fā)布時(shí)間：2018-02-24 10:42

  本文關(guān)鍵詞： 小細(xì)胞肺癌 TNM分期系統(tǒng) 腦預(yù)防性放療 腦轉(zhuǎn)移　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討小細(xì)胞肺癌(small cell lung cancer,SCLC)患者經(jīng)腦預(yù)防性放療(prophylactic cranial irradiation,PCI)后發(fā)生腦轉(zhuǎn)移的高危因素。材料和方法:收集2010年5月至2016年5月在吉林大學(xué)白求恩第一醫(yī)院有明確病理證實(shí)的SCLC患者99例,入組的所有患者均進(jìn)行4~6周期EP或EC方案化療并行胸部放療,胸部放療后1個(gè)月左右行腦預(yù)防性放療。入組的99例患者中,32例發(fā)生腦轉(zhuǎn)移,67例未發(fā)生腦轉(zhuǎn)移,中位腦轉(zhuǎn)移發(fā)生時(shí)間為24.05個(gè)月。入組的99例患者中有9例失訪(其中腦轉(zhuǎn)移組3例、對照組6例),隨訪率90.9%,中位隨訪時(shí)間23.0個(gè)月。按照腦轉(zhuǎn)移發(fā)生與否,患者被分為腦轉(zhuǎn)移組(試驗(yàn)組)及對照組。對兩組間初診時(shí)腫瘤TNM分期、性別、年齡和PCI劑量等因素進(jìn)行統(tǒng)計(jì)學(xué)分析。主要采用單因素分析及多因素分析。單因素分析采用配對t檢驗(yàn)、卡方檢驗(yàn)及秩和檢驗(yàn);對于單因素分析中具有統(tǒng)計(jì)學(xué)差異的結(jié)果,進(jìn)一步進(jìn)行Logistic回歸多因素分析。結(jié)果:2組間單因素分析結(jié)果提示:(1)T_(1-2)的SCLC患者發(fā)生腦轉(zhuǎn)移3例,發(fā)生率為10.7%,T_3的為32.0%,T_4的為61.9%,經(jīng)比較不同T分期患者的腦轉(zhuǎn)移發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(P=0.001);N_(0-1)的患者腦轉(zhuǎn)移的發(fā)生率為6.45%,N_(2-3)的為44.1%,N分期高的患者腦轉(zhuǎn)移發(fā)生率非常明顯高于N分期低的患者(P0.001);(2)病程中發(fā)生其他組織臟器轉(zhuǎn)移、肺部病灶控制不佳的患者腦預(yù)防性放療后腦轉(zhuǎn)移率高于未發(fā)生其他組織臟器轉(zhuǎn)移及肺部病灶穩(wěn)定的患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05);(3)SCLC男性患者PCI后腦轉(zhuǎn)移的發(fā)生率為41.2%,女性患者為12.9%,男性明顯高于女性(P=0.005);(4)PCI后發(fā)生腦轉(zhuǎn)移組,PCI中位劑量為25.3±1.23 Gy,對照組為26.5±3.01 Gy,兩組差異有統(tǒng)計(jì)學(xué)意義(P=0.023)。多因素分析結(jié)果提示:(1)對于腫瘤TNM分期因素,T分期越高,發(fā)生腦轉(zhuǎn)移的風(fēng)險(xiǎn)越大,OR值為3.648,95%CI為1.491~8.928;N分期越高,發(fā)生腦轉(zhuǎn)移的風(fēng)險(xiǎn)越大,N分期為2~3期者腦轉(zhuǎn)移的風(fēng)險(xiǎn)是0~1期的10.6倍,95%CI為2.502~44.535;(2)病程中發(fā)生其他組織臟器轉(zhuǎn)移的患者,PCI后腦轉(zhuǎn)移發(fā)生率更高,OR值為4.873,95%CI為1.218~19.492;肺部病灶控制不佳者,PCI后腦轉(zhuǎn)移發(fā)生率更高,OR值為3.983,95%CI為1.092~14.526;(3)對于性別因素,SCLC男性患者PCI后發(fā)生腦轉(zhuǎn)移的風(fēng)險(xiǎn)是女性的4.545倍,95%CI為1.233~16.667;(4)對于PCI劑量因素,PCI劑量越大,發(fā)生腦轉(zhuǎn)移的風(fēng)險(xiǎn)越小,OR值為0.855,95%CI為0.739~0.988。結(jié)論:SCLC患者初診T、N分期高、病程中發(fā)生其他組織臟器轉(zhuǎn)移、肺部病灶控制不佳為PCI后腦轉(zhuǎn)移發(fā)生的獨(dú)立影響因素,男性患者有更高的PCI后腦轉(zhuǎn)移發(fā)生率,而略高于常規(guī)的PCI劑量,即PCI劑量的提高或可減少顱內(nèi)失敗的幾率、改善患者預(yù)后。但仍需進(jìn)一步大樣本量研究給予證實(shí)。
[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 鹵1.23 Gy in patients with cerebral metastasis and 26.5 鹵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 鹵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 鹵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 鹵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 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王中,崔崗,周岱,鮑耀東;小腦轉(zhuǎn)移癌的診斷與治療(附27例報(bào)告)[J];江蘇醫(yī)藥;1997年05期

2 王貴泉,張建玉;以腦轉(zhuǎn)移為主要表現(xiàn)的肺癌2例[J];現(xiàn)代中西醫(yī)結(jié)合雜志;1999年12期

3 錢利華,回允中;皮膚惡性黑色素瘤伴早期腦轉(zhuǎn)移一例[J];中華神經(jīng)外科雜志;2000年04期

4 陳玉娟,田廣利;腦轉(zhuǎn)移癌誤診為椎基底動脈供血不足[J];臨床誤診誤治;2000年05期

5 宋永浩,夏炎春,曹民生;全腦加立體定向放射治療腦轉(zhuǎn)移癌[J];寧波醫(yī)學(xué);2000年07期

6 王付本,莊建生;司莫司汀、威猛聯(lián)合治療腦轉(zhuǎn)移癌療效觀察[J];陜西腫瘤醫(yī)學(xué);2000年02期

7 楊水泉,馬海生;以腦轉(zhuǎn)移為首發(fā)癥狀的肺癌20例臨床分析[J];臨床薈萃;2002年01期

8 管巒,趙保民;30例以腦轉(zhuǎn)移為首發(fā)癥狀的肺癌的綜合治療[J];河南腫瘤學(xué)雜志;2004年06期

9 李鑫;齊宇;;原發(fā)性支氣管肺癌腦轉(zhuǎn)移15例誤診分析[J];中國實(shí)用神經(jīng)疾病雜志;2006年04期

10 朱向幟;王綠化;;局部晚期非小細(xì)胞肺癌腦轉(zhuǎn)移與預(yù)防性腦照射[J];中國肺癌雜志;2006年04期

相關(guān)會議論文 前10條

1 李博;陳火明;楊明;孫鎖柱;石建玲;王爭明;孫蕾;左敏;王凱金;劉冰;李真真;;肺腺癌腦轉(zhuǎn)移的臨床病理特點(diǎn)及酪氨酸激酶抑制劑在腦轉(zhuǎn)移治療中的作用[A];中國腫瘤內(nèi)科進(jìn)展 中國腫瘤醫(yī)師教育（2014）[C];2014年

2 趙元華;臧愛華;;腦轉(zhuǎn)移癌的診斷及其治療進(jìn)展[A];湖北省第21屆腫瘤學(xué)術(shù)大會論文匯編[C];2011年

3 韓東明;李玉俠;楊瑞民;王紅坡;竇文廣;王清華;;“腦先行型”肺癌與其腦轉(zhuǎn)移的影像學(xué)特征[A];中華醫(yī)學(xué)會第十三屆全國放射學(xué)大會論文匯編（下冊）[C];2006年

4 韓東明;李玉俠;楊瑞民;王紅坡;竇文廣;王清華;;“腦先行型”肺癌與其腦轉(zhuǎn)移的影像學(xué)特征[A];中華醫(yī)學(xué)會放射學(xué)分會第八屆全國心胸影像學(xué)術(shù)大會暨河南省第十二次放射學(xué)術(shù)會議論文匯編[C];2006年

5 張童童;李青;;不同分子亞型乳腺癌腦轉(zhuǎn)移患者的臨床特征和預(yù)后[A];中國腫瘤內(nèi)科進(jìn)展 中國腫瘤醫(yī)師教育（2014）[C];2014年

6 元芳;;肺癌并發(fā)腦轉(zhuǎn)移患者的放療護(hù)理[A];中華護(hù)理學(xué)會全國腫瘤護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2009年

7 王華慶;錢正子;;腦轉(zhuǎn)移癌的藥物治療現(xiàn)狀及進(jìn)展[A];第四屆中國腫瘤學(xué)術(shù)大會暨第五屆海峽兩岸腫瘤學(xué)術(shù)會議論文集[C];2006年

8 袁瑛;;TKI在NSCLC腦轉(zhuǎn)移中的應(yīng)用[A];2013年第六屆國家級分子靶點(diǎn)藥物治療新進(jìn)展學(xué)習(xí)班暨浙江省腫瘤化療學(xué)術(shù)年會論文集[C];2013年

9 黃本卿;;預(yù)見性安全管理護(hù)理在乳腺癌腦轉(zhuǎn)移患者中的應(yīng)用[A];2012年“河南省腫瘤�？谱o(hù)士職業(yè)安全防護(hù)及新技術(shù)交流”學(xué)術(shù)會議論文集[C];2012年

10 吳世凱;王秋生;黃焰;孫冰;孟祥穎;;乳腺癌腦轉(zhuǎn)移預(yù)測模型的建立和分析[A];中國腫瘤內(nèi)科進(jìn)展 中國腫瘤醫(yī)師教育（2014）[C];2014年

相關(guān)重要報(bào)紙文章 前7條

1 江西 教授 劉泉開;腦轉(zhuǎn)移癌治療不言放棄[N];家庭醫(yī)生報(bào);2004年

2 張彥;腦轉(zhuǎn)移危險(xiǎn)可通過肺癌大小預(yù)測[N];保健時(shí)報(bào);2005年

3 孫云龍;肢體障礙應(yīng)分清是癌癥腦轉(zhuǎn)移還是腦血栓[N];衛(wèi)生與生活報(bào);2006年

4 王根華 萬方;有效控制肺癌多發(fā)性腦轉(zhuǎn)移[N];中國醫(yī)藥報(bào);2002年

5 徐筱舫;新法治腦轉(zhuǎn)移指南成“決策樹”[N];健康報(bào);2008年

6 唐振中;腦轉(zhuǎn)移癌不存在血腦屏障[N];健康報(bào);2007年

7 張紓難;中醫(yī)臨床禁忌系列講座：肺積[N];中國中醫(yī)藥報(bào);2003年

相關(guān)博士學(xué)位論文 前5條

1 常杰;非小細(xì)胞肺癌發(fā)生腦轉(zhuǎn)移的風(fēng)險(xiǎn)因素評估與腦轉(zhuǎn)移患者的靶向治療效果研究[D];北京協(xié)和醫(yī)學(xué)院;2012年

2 陳艷;Gefitinib治療肺癌腦轉(zhuǎn)移藥代動力學(xué)基礎(chǔ)研究[D];北京協(xié)和醫(yī)學(xué)院;2012年

3 劉志芳;非小細(xì)胞肺癌腦轉(zhuǎn)移病灶~（11）C-膽堿提取的臨床應(yīng)用及其生存因素的相關(guān)研究[D];山東大學(xué);2012年

4 孫殿水;非小細(xì)胞肺癌腦轉(zhuǎn)移的臨床特征與分子生物學(xué)標(biāo)記的研究[D];山東大學(xué);2014年

5 丁曉;非小細(xì)胞肺癌腦轉(zhuǎn)移的危險(xiǎn)因素[D];北京協(xié)和醫(yī)學(xué)院;2012年

相關(guān)碩士學(xué)位論文 前10條

1 葛蒙晰;FRAS1、CXCL14、gp130蛋白表達(dá)與NSCLC腦轉(zhuǎn)移的相關(guān)性研究[D];復(fù)旦大學(xué);2014年

2 楊慧;非小細(xì)胞肺癌腦轉(zhuǎn)移相關(guān)臨床及影像因素探討[D];濟(jì)南大學(xué);2015年

3 蘇鵬程;全顱放療對于EGFR突變非小細(xì)胞腦轉(zhuǎn)移更敏感[D];山西醫(yī)科大學(xué);2016年

4 王秋生;乳腺癌腦轉(zhuǎn)移危險(xiǎn)因素的臨床研究[D];安徽醫(yī)科大學(xué);2016年

5 徐蘭蘭;小細(xì)胞肺癌患者腦轉(zhuǎn)移臨床危險(xiǎn)因素的分析研究[D];鄭州大學(xué);2016年

6 彭麗;乳腺癌腦轉(zhuǎn)移病理特征及預(yù)后[D];浙江大學(xué);2016年

7 張婧;非小細(xì)胞肺癌腦轉(zhuǎn)移的綜合治療觀察[D];昆明醫(yī)科大學(xué);2016年

8 何昊;EGFR-TKIs與NSCLC腦轉(zhuǎn)移發(fā)生及其相關(guān)生物學(xué)因素分析[D];第三軍醫(yī)大學(xué);2016年

9 鄭貴文;60例不同EGFR突變狀態(tài)非小細(xì)胞肺癌腦轉(zhuǎn)移治療及預(yù)后分析[D];山東大學(xué);2017年

10 楊碩;小細(xì)胞肺癌腦預(yù)防性放療后發(fā)生腦轉(zhuǎn)移的高危因素分析[D];吉林大學(xué);2017年

，

本文編號：1529938