肺腺癌腦膜轉(zhuǎn)移患者生存情況及預(yù)后因素分析
發(fā)布時間：2018-09-18 15:37
【摘要】：目的和背景尸檢研究顯示非小細(xì)胞肺癌(non-small cell lung cancer,NSCLC)腦轉(zhuǎn)移(brain metastases,BM)發(fā)病率為41%,腦膜轉(zhuǎn)移(leptomeningeal metastases,LM)發(fā)病率為9%。NSCLC-LM最常見的病理類型為肺腺癌,占NSCLC的84-97%。LM是肺腺癌患者中樞神經(jīng)系統(tǒng)(central nervous system,CNS)災(zāi)難性的并發(fā)癥,生存期短,如不治療,患者的中位生存期在4-6周之間。近年來肺腺癌治療方面的進(jìn)展尤其是表皮生長因子受體酪氨酸激酶抑制劑(EGFR-TKIs)的應(yīng)用和影像學(xué)診斷技術(shù)的進(jìn)步,診斷為LM的病人數(shù)量越來越多。但由于血腦屏障(blood-brain barrier,BBB)的存在,抗腫瘤藥物的腦脊液(cerebrospinal fluid,CSF)滲透性差,腦膜轉(zhuǎn)移治療效果有限,預(yù)后很差。肺腺癌腦膜轉(zhuǎn)移治療及預(yù)后方面的臨床研究近年來逐漸增多。了解影響肺腺癌腦膜轉(zhuǎn)移患者預(yù)后的相關(guān)因素,對我們更好的認(rèn)知疾病、判斷預(yù)后、合理選擇治療方案均有重大的指導(dǎo)意義。但目前影響肺腺癌腦膜轉(zhuǎn)移患者預(yù)后的因素尚未完全確定。為探討影響肺腺癌腦膜轉(zhuǎn)移患者預(yù)后的相關(guān)因素,進(jìn)一步為臨床治療決策的選擇提供客觀依據(jù),我們對65例有完整隨訪資料的肺腺癌腦膜轉(zhuǎn)移患者的臨床資料進(jìn)行了回顧性分析。方法回顧性收集2008年1月至2015年1月鄭州大學(xué)人民醫(yī)院腫瘤科收治的肺腺癌腦膜轉(zhuǎn)移患者的臨床資料并進(jìn)行隨訪,對所有隨訪患者的資料建立數(shù)據(jù)庫,資料完整者納入本研究,采用SPSS21.0進(jìn)行統(tǒng)計學(xué)分析,用Kaplan-Meier法進(jìn)行生存分析,繪制生存曲線,使用Log-rank檢驗進(jìn)行單因素分析,Cox回歸模型進(jìn)行多因素回歸分析。結(jié)果65例肺腺癌腦膜轉(zhuǎn)移患者中位生存時間為7.4個月,1年生存率為6.2%(4/65)。Log-rank單因素分析顯示,性別、年齡、吸煙史、腦膜轉(zhuǎn)移時間、是否合并腦轉(zhuǎn)移與患者的總生存時間無顯著相關(guān)(P值均0.05),而美國東部腫瘤協(xié)作組(Eastern Cooperative Oncology Group,ECOG)體力狀況(performance status,PS)評分、是否接受腦室腹腔分流(Ventriculo-Peritoneal shunt,V-P分流)手術(shù)、EGFR-TKIs靶向治療、全身化療(Systemic chemotherapy,SC)、全腦放療(Whole Brain Radiotherapy,WBRT)、腦膜轉(zhuǎn)移時的臨床癥狀和EGFR基因狀態(tài)與患者的總生存時間顯著相關(guān)(P值均0.05)。多因素回歸分析顯示,EGFR基因狀態(tài)、ECOG PS評分、SC、V-P分流手術(shù)與否是肺腺癌腦膜轉(zhuǎn)移患者患者獨立的預(yù)后因素(P值均0.05)結(jié)論肺腺癌腦膜轉(zhuǎn)移整體預(yù)后差,EGFR基因突變的腦膜患者預(yù)后相對較好。EGFR-TKIs靶向治療、全身化療和腦室腹腔分流手術(shù)有助于延長肺腺癌腦膜轉(zhuǎn)移患者的生存時間,改善其預(yù)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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
本文編號：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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
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