Predictive Factors for Brain Metastases in Early-Stage Non-Small Cell Lung Cancer

早期非小細胞肺癌腦部轉移之危險因子分析

梁家郡(Chia-Chun Liang) ； 劉幕台(Mu-Tai Liu) ； 張東浩(Tung-Hao Chang) ； 畢祖平(Chu-Ping Pi) ； 黃家俊(Chia-Chun Huang) ； 洪儷中(Li-Chung Hung) ； 周采薇(Tsai-Wei Chou)

《放射治療與腫瘤學》 21卷3期 (2014/09) Pp. 233-234

https://doi.org/10.6316/TRO/201421(3)223

摘要

目的：腦部轉移在局部晚期非小細胞肺癌為最常見的遠端轉移，根據之前的研究大約有22%～55%的局部晚期非小細胞肺癌之後會有腦部的轉移。但是針對早期的非小細胞肺癌對此相關的研究並不多。因此，本篇文章主要目地為探討早期非小細胞肺癌腦部轉移的機率和危險因子分析。材料與方法：本研究收集了從2007年1月到2012年6月於彰化基督教醫院診斷為臨床分期T1～2，N0～1，M0的病人，並再依下列條件作適當的排除：1、病人診斷後沒有在本院繼續追縱治療、資料不足或是追蹤時間小於3個月；2、根據病人的病歷記錄，病人有兩種以上的癌症診斷；3、病人有接受手術治療並且病理分期的T ＞ 2或N ＞ 1。經過篩選後的病人，依其病歷資料將診斷年齡、性別、細胞組織型態、組織惡性度分級、T期別、N期別、病灶所在的肺葉、日常體能狀態和病人所接受的治療等因子作單變項和多變項分析其與之後腦部轉移的相關性。結果：自2007年1月至2012年6月，總共有260位早期肺癌的病人在我們醫院被診斷，經過排除條件的篩選後，共有177位病人的相關因子被尋找出來並加以分析。在本篇研究當中，追蹤時間的中位數為28.4個月（3～74個月）。總共有18位病在在追蹤其間發現有腦部轉移。5年的腦部轉移累積風險為19%。從診斷到發現病人腦部轉移的中位時間為17.8個月（1.8～60.6個月），有腦部轉移的病人之中位診斷年齡為69.5歲。在單變項和多變項分析所得之結果中，T2期別和是否接受手術治療皆和腦部轉移有明顯的相關。另外，在多變項分析中，年齡（＞60歲）和腦部轉移可能有相關性（p= 0.053）。結論：本篇研究發現，針對早期非小細胞肺癌之病人，5年的腦部轉移累積風險為19%。T2分期和是否有接受手術治療和之後的腦部轉移有明顯的相關性。

關鍵字

早期 ； 非小細胞肺癌 ； 腦轉移 ； 預測因子

並列摘要

Purpose: The risk of developing brain metastases in locally advanced non-small cell lung cancer (NSCLC) is approximately 22%-55% and has been discussed in many studies. However the risk for patients with early stage NSCLC is less defined. The purpose of this study is to evaluate the risk factors of developing brain metastases in early stage NSCLC. Materials and Methods: Patients diagnosed with early stage (clinical T1-2, N0-1, M0) NSCLC in our institution from Jan, 2007 to Jun, 2012 were surveyed. Exclusion criteria were (1) patients who did not received regular follow up at our hospital or those with missing data or who had a follow up time ＜ 3 months. (2) Double cancer (3) pathological ＞T2 or ＞N1 disease. Factors such as age at diagnosis, gender, cell type, histological grade, T stage, N stage, different pulmonary lobe, performance status and treatment modality were reviewed from their chart records and analyzed using Kaplan-Meier and Cox regression to estimate the association and significance with brain metastases. Results: From Jan, 2007 to Jun, 2012, 260 patients were diagnosed with early stage NSCLC. Eighty three patients were excluded and 177 were enrolled in this study. The median follow up time of all the patients was 28.4 months (range, 3-74 months). Brain metastases were identified in 18 patients. The 5-year risk of developing brain metastases was 19%. The median time from diagnosis to brain metastases was 17.8 months (range, 1.8-60.6 months) and the median age at diagnosis was 69.5 years. In univariate and multivariate analysis, stage (T2) and surgery status (without surgery) had strong associations with developing brain metastases (p= 0.007 and 0.001 in univariate, p= 0.028 and 0.007 in multivariate respectively). Age (＞60 y/o) showed a trend towards association with brain metastases in multivariate analysis (p= 0.053). Conclusions: Our results showed that the 5-year risk of developing brain metastases was 19% in early stage NSCLC. Tumor stage (T2) and surgery status (without surgery) were significant predictors for brain metastases.

並列關鍵字

Early-stage ； Non-small cell lung cancer ； Brain metastases ； Predictive factors