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目的:探讨非小细胞肺癌(NSCLC)脑转移不同治疗方法的疗效分析及预后因素。方法:回顾性分析2001-01-2006-06我科治疗的71例NSCLC脑转移患者,14例行手术+放疗±化疗,26例行单纯放疗,31例行放疗+化疗。42例行全脑放疗±局部加量,29例行全脑放疗+三维适形调强放疗。全部病例定期随访直至死亡,分别行单因素和多因素分析。结果:全组中位生存期为10个月,1、2和3年生存率分别为29.58%(21/71)、16.90%(12/71)和8.45%(6/71)。单因素分析显示,KPS评分、病理类型、脑转移数目、脑转移大小、原发灶控制、中枢外转移、治疗方法、放疗剂量、放疗方式和近期疗效对生存期有影响。多因素分析显示,KPS评分、脑转移数目、原发灶控制、中枢外转移和近期疗效是独立的生存预后因素。结论:NSCLC脑转移的主要预后因素是KPS评分、脑转移数目、原发灶控制、中枢外转移、近期疗效。积极治疗可适当延长生存期。
Objective: To investigate the curative effect and prognostic factors of different treatment of non-small cell lung cancer (NSCLC) brain metastases. Methods: A retrospective analysis of 71 patients with NSCLC brain metastases treated in our department from January 2001 to June 2006 was performed. 14 patients underwent surgery plus radiotherapy ± chemotherapy, 26 patients received simple radiotherapy and 31 patients received radiotherapy and chemotherapy. 42 cases of global brain radiotherapy + local dosage, 29 cases of whole brain radiotherapy + three-dimensional conformal IMRT. All cases were followed up until death, single and multivariate analysis respectively. Results: The median overall survival was 10 months. The 1, 2 and 3 year survival rates were 29.58% (21/71), 16.90% (12/71) and 8.45% (6/71), respectively. Univariate analysis showed that KPS score, pathological type, number of brain metastases, size of brain metastases, primary tumor control, central metastasis, treatment methods, radiation dose, radiation therapy and short-term efficacy of survival have an impact. Multivariate analysis showed that KPS score, number of brain metastases, primary tumor control, central extracranial metastasis and short-term efficacy were independent prognostic factors. CONCLUSION: The main prognostic factors of NSCLC brain metastasis are KPS score, number of brain metastases, primary tumor control, central external metastasis and short-term curative effect. Active treatment may be appropriate to extend the survival period.