天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1261-1265.doi: 10.11958/20170823

• 临床研究 • 上一篇    下一篇

预防性全脑照射及其不同介入时机对局限期 小细胞肺癌预后的影响

霍东杰 1， 陆艳荣 1， 王海峰 1， 张玲 1， 阿不力克木江·阿地力 1， 李月 2， 张瑾熔 1△   

  1. 基金项目： 新疆维吾尔自治区自然科学基金 （2016D01C376） 作者单位： 1 新疆医科大学附属肿瘤医院胸腹放疗科 （邮编 830011）； 2 复旦大学附属华东医院 作者简介： 霍东杰 （1990）， 男， 硕士在读， 主要从事小细胞肺癌研究 △通讯作者 E-mail: zjr8043@163.com
  • 收稿日期:2017-07-21 修回日期:2017-09-26 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 张瑾熔 E-mail:zjr8043@163.com
  • 基金资助:
    新疆维吾尔自治区自然科学基金联合基金

Effects of prophylactic cranial irradiation and its different optional times on prognosis of limited-stage small cell lung cancer

HUO Dong-jie1, LU Yan-rong1, WANG Hai-feng1, ZHANG Ling1, Abulikemujiang Adili1, LI Yue2, ZHANG Jin-rong1△   

  1. 1 Department of Thoraco-abdominal Radiotherapy, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, China; 2 The Affiliated Huadong Hospital of Fudan University △Corresponding Author E-mail:zjr8043@163.com
  • Received:2017-07-21 Revised:2017-09-26 Published:2017-12-15 Online:2017-12-15

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摘要： 目的 探究预防性全脑照射 （PCI） 及其不同介入时机对经基础治疗达完全缓解 （CR） 的局限期小细胞肺癌 （LSCLC）患者预后的影响。方法 回顾性分析 184 例 LSCLC 患者的临床资料， 在基础治疗达 CR 的前提下以有无 PCI 干预分为 2 组， 其中 PCI 组 50 例（27.2%）， 非 PCI 组 134 例（72.8%）； 又以是否完成 4 周期化疗将 PCI 组分为 PCI1 组（n=20）和 PCI2 组（n=30）。基础治疗的化疗方案、 照射方式及剂量一致。结果 PCI 组、 非 PCI 组脑转移率 分别为 14.0%、 30.6%， 差异有统计学意义（P＜0.05）。PCI 组的中位生存时间及 1、 2、 3 年生存率分别为 25 个月 （95%CI： 21.487~28.513）， 54%、 36%、 15%， 而非 PCI 组为 17 个月（95%CI： 15.175~18.825）， 37%、 18%、 13%， 2 组中位 生存时间比较差异有统计学意义 （P＜0.05）。PCI1 组、 PCI2 组的脑转移率分别为 10.0%、 16.7%， 差异无统计学意义， 两亚组间中位生存时间差异亦无统计学意义。结论 PCI 可降低 LSCLC 患者脑转移率、 延长总生存时间 （OS）， 而不 同介入时机的 PCI 对 LSCLC 的预后无明显影响。

关键词: 肺肿瘤, 癌, 小细胞, 颅脑照射, 预后, 肿瘤转移, 局限期小细胞肺癌, 预防性全脑照射, 脑转移, 总生存期

Abstract: Objective To observe the impact of the prophylactic cranial irradiation (PCI) and its different interventional times on the prognosis of patients with limited-stage small cell lung cancer (LSCLC) who received comprehensive therapy of complete response (CR). Methods A total of 184 LSCLC patients who received radiotherapy and chemotherapy based on comprehensive treatment were retrospectively analyzed. Patients were divided into two groups based on with or without PCI intervention. There were 50 patients (27.2%) in the PCI group and 134 patients (72.8%) in the non PCI group. The PCI group was subdivided into two groups, PCI1 group (n=20) and PCI2 group (n=30), according to whether patients completed 4 cycles of chemotherapy. Chemotherapy regimen, irradiation method and dose were identical for two groups. Results The brain metastasis rates were 14.0% and 30.6% for PCI group and non PCI group. There was significant difference in brain metastasis rate between the two groups (P＜0.05). The median survival times were 25 months (95%CI: 21.487-28.513) and 17 months (95%CI: 15.175-18.825) for PCI group and non PCI group (P＜0.05). The 1,2 and 3-year survival rates were 54%, 36%,15% and 37%,18%,13% for the two groups. There were no significant differences in brain metastasis rates between PCI1 group and PCI2 group (10.0% and 16.7%). There was no significant difference in median survival time between the two subgroups. Conclusion PCI can reduce the incidence of SCLC brain metastases, and prolong the overall survival time. However, different intervention times of PCI have no significant influence on the prognosis of LSCLC.

Key words: lung neoplasms, carcinoma, small cell, cranial irradiation, prognosis, neoplasm metastasis, limited-stage small cell lung cancer, prophylactic cranial irradiation, brain metastasis, overall survival time