肺癌脑转移252例综合治疗临床分析

目的　探讨肺癌脑转移综合治疗的疗效及预后影响因素。方法　回顾性分析了１９９０年１ 月～１９９６ 年１２ 月采用不同方法治疗的２５２ 例肺癌脑转移患者生存期与生存率。结果　转移灶手术切除及γ或 Ｘ刀治疗辅以放疗、化疗以及放疗与化疗联合组的中位生存期及１ 、２ 年生存率明显高于单纯放疗与化疗组（ Ｐ＜ ００１ 及 Ｐ＜ ００５） ，肺癌的病理类型对生存期与生存率无明显影响（ Ｐ＞００５） ；单发转移及无颅外转移者生存期（ 中位生存期分别为８５ 和８５ 个月） 与生存率（１ 年生存率分别为３５ ％ 和２９ ％ ，２ 年生存率分别为１１ ％ 和８ ％ ） 明显高于多发转移及伴颅外血行转移者（ Ｐ＜ ００１） ；高年龄者（ ≥５０ 岁）１ 年生存率（２９ ％ ） 明显高于低年龄组（１５ ％ ， Ｐ＜ ００５） 。结论　转移灶的手术切除及γ或 Ｘ刀治疗加放疗和化疗是治疗肺癌脑转移患者的首选方法，转移的数量与部位多少及年龄是影响预后的因素。

Clinical analysis of combination therapy for 252 patients of lung cancer with brain metastasis

OBJECTIVE: To evaluate the efficacy of combination therapy and prognostic factors for lung cancer patients with brain metastasis. METHODS: The survival time and survival rates with various therapeutic methods were analyzed retrospectively in 252 patients with brain metastasis. RESULTS: The median survival time and 1, 2 year survival rates in surgery and X-knife plus radio-chemotherapy group and combination therapy of radiotherapy with chemotherapy were significantly longer than radio-chemotherapy alone group (P < 0.01 and P < 0.05); the pathological type of lung cancer did not affect the survival time and survival rate (P > 0.05); the survival time and survival rate of single brain metastasis (median survival time was 8.5 months 1, 2 year survival rates were 35% and 11% respectively) and non-extrabrain metastasis (8.5 months, 29%, 8%) were much longer than multiple brain metastasis and extrabrain metastasis (P < 0.01); the 1 year survival rate of older patients(> or = 50 years, 29%) were significantly higher than younger ones (< 50 years, 15%) (P < 0.05). CONCLUSIONS: Combination therapy of surgery and X-knife plus radio-chemotherapy are better than radio-chemotherapy alone for brain metastasis of lung cancer, severity of metastasis and patients' age are the prognostic factors.