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目的探讨非小细胞肺癌合并孤立性脑转移灶的手术治疗效果,分析影响患者生存期的因素。方法回顾性分析2005年1月-2011年5月46例接受手术治疗的非小细胞肺癌合并孤立性脑转移灶患者的临床资料,其中男35例,女11例;年龄35～67岁,平均53.2岁;所有患者均行肺部原发肿瘤及脑部转移肿瘤切除术,其中肺叶切除术42例,全肺切除术4例,术后全部患者行全脑放射治疗,部分患者行系统化学疗法3～6周期。对随访患者的生存时间采用对数秩检验,分析影响生存率的因素。结果术后病理检查提示腺癌27例,鳞癌15例,大细胞癌2例,其他类型2例。患者1年生存率80%,2年生存率41%,3年生存率14%,中位生存期23个月,平均生存期(27.8±4.5)个月(乘积极限法)。对数秩检验结果提示N0与N1患者比N2患者生存率高(P=0.024),腺癌患者生存期比非腺癌患者生存期长(P=0.002)。结论外科手术治疗非小细胞肺癌合并孤立性脑转移灶的患者可以取得良好的治疗效果,腺癌患者及无纵隔淋巴结转移的患者生存期长。
Objective To investigate the surgical treatment of non-small cell lung cancer with solitary brain metastases and analyze the factors affecting the survival of patients. Methods The clinical data of 46 patients with solitary brain metastasis from 46 patients with surgical treatment of solitary brain metastases from January 2005 to May 2011 were retrospectively analyzed. There were 35 males and 11 females, aged from 35 to 67 years, with an average of 53.2 years old; all patients underwent primary lung cancer and brain tumor resection, of which 42 cases of lobectomy, pneumonectomy in 4 cases, all patients undergoing whole brain radiation therapy, some patients undergoing systemic chemotherapy 3 to 6 cycles. Survival time of follow-up patients using log-rank test to analyze the factors that affect the survival rate. Results Postoperative pathological examination revealed adenocarcinoma in 27 cases, squamous cell carcinoma in 15 cases, large cell carcinoma in 2 cases and other types in 2 cases. The 1-year survival rate was 80%, the 2-year survival rate was 41%, the 3-year survival rate was 14%, the median survival time was 23 months and the average survival time was 27.8 ± 4.5 months. Log-rank test showed that patients with N0 and N1 had a higher survival rate than those with N2 (P = 0.024). Patients with adenocarcinoma had longer survival than patients with non-adenocarcinoma (P = 0.002). Conclusion Surgical treatment of non-small cell lung cancer with isolated brain metastases patients can achieve good results, patients with adenocarcinoma and patients without mediastinal lymph node metastasis longer survival.