2016 年第 1 期 第 14 卷

肺癌脑膜转移的临床特征及预后因素分析

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关键词：肺癌脑膜转移预后因素

• 摘要：
• 【摘要】目的 探讨肺癌脑膜转移癌（LM）患者的临床特点和治疗方法并进行预后因素分析。方法 回顾性分析在2002年12月至2014年2月间肺癌脑膜转移患者的71例的临床特征和随访资料，采用Kaplan-Meier法绘制生存曲线，并分析影响LM患者预后的因素。结果 71例LM患者的中位生存时间150d，1年生存率为22.5%（16/71）。单因素分析显示，KPS评分、原发肿瘤控制情况、治疗情况、近期疗效及直接死亡原因与LM患者的生存时间有关（均P<0.05）。多因素分析显示，近期疗效及直接死亡原因是影响LM患者预后的独立因素（均P<0.05）。结论 治疗近期效果及直接死亡原因是影响LM患者的独立预后因素。全身系统治疗（包括全身治疗及局部治疗联合治疗）可提高LM患者的生存时间，建议作为首选治疗方案，根据患者具体情况，选择单纯全身治疗或单纯局部治疗可改善患者中枢神经系统症状，提高患者生命质量。
• Objective: To discuss the clinical features, treatment strategies, and prognostic factors of lung cancer-induced leptomeningeal metastasis (LM).Methods: This retrospective analysis studied the clinical and follow-up data of 71 patients with LM who received treatment in our hospital from December 2002 to February 2014. Patients’ survival curves were plotted using the Kaplan–Meier approach, and factors influencing patient prognosis were analyzed.Results: The median survival time of these 71 patients was 150 d, and the 1-year survival rate was 22.5% (16/71). Univariate analysis showed that the KPS score, control of primary tumor, treatment strategy, short-term efficacy, and direct cause of death were significantly associated with the survival of patients with LM (P < 0.05 for all factors). Multivariate analysis identified short-term efficacy and direct cause of death as the independent prognostic factors for patients with LM (P < 0.05 for both factors). As compared with supportive treatment, systemic or local treatment alone improved patients’ quality of life (P = 0.027), while combined treatment (systemic and local treatment) significantly prolonged their survival (P = 0.001).Conclusion: Short-term efficacy and direct cause of death are 2 independent prognostic factors for patients with LM. Combined treatment (systemic treatment and local treatment) could prolong the survival of these patients, and was thus suggested as the preferred treatment strategy for clinical practice. Based on patients’ specific conditions, systemic or local treatment alone could reduce central nervous system symptoms and improve patients’ quality of life.