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目的评估非小细胞肺癌合并孤立性脑转移患者接受外科治疗的有效性。方法回顾分析21例行脑部和胸部病灶联合切除的非小细胞肺癌孤立性脑转移患者临床及随访资料。结果 21例患者进行了孤立性脑转移病灶切除和后续的肺癌根治术1,8例(86%)患者有纵隔淋巴结转移,其中N1淋巴结阳性8例,N2淋巴结阳性10例。中位生存期32个月(95%CI 15～49个月)1,2、和5年生存率分别为70%4、3%和22%。对可能影响预后的指标进行单因素分析,提示淋巴结转移是影响预后的危险因素(P=0.002)。结论在保证病灶完全切除和手术耐受性前提下,对胸部和脑部病灶同时采取积极的外科治疗策略是治疗非小细胞肺癌孤立性脑转移的最佳方案。
Objective To evaluate the effectiveness of surgical treatment in patients with non-small cell lung cancer and solitary brain metastases. Methods The clinical and follow-up data of 21 patients with solitary brain metastasis of non-small cell lung cancer who underwent combined resection of brain and chest lesions were retrospectively analyzed. Results Twenty-one patients (n = 18) had mediastinal lymph node metastasis after resection of lone brain metastases and radical resection of lung cancer (n = 8). There were 8 positive cases of N1 lymph nodes and 10 positive cases of N2 lymph nodes. The median 1, 2, and 5-year survival rates at 32 months (95% CI, 15-49 months) were 70%, 4%, 3%, and 22%, respectively. Univariate analysis of the possible prognostic indicators suggested that lymph node metastasis was a risk factor for prognosis (P = 0.002). Conclusion Under the premise of complete resection and surgical tolerance, it is the best strategy to treat solitary brain metastasis of non-small cell lung cancer while taking active surgical treatment for both chest and brain lesions.