| Objective To investigate the clinical features and treatment status of NSCLC patients with brain metastases retrospectively,assess the prognostic implications of baseline clinical variable,and explore more effective patterns of treatment so as to provide a reference for clinical practice.Methods A retrospective analysis was performed for 178 NSCLC patients with brain metastases from the first hospital of Soochow University during 2012.06 and 2015.06,primary tumor was diagnosed by histopathology and brain metastases was confirmed by CT,MRI,or histopathology.The Kaplan-Meier method was used to calculate survival rates and draw survival curves,was used for single factor analysis,the log-rank test and the Cox proportional hazards model was used to conduct univariate and multivariate analyses of baseline prognostic factors respectively.Statistical significance was defined as P < 0.05.Results1.The 3-,6-,9-,12-,and 18-month survival rates were 92.1%,84.7%,78.2%,69.1%,49.0%,respectively,and the median survival time was 18 months.2.The univariate analysis showed that pathological type,radical surgery for the primary tumor,number of brain metastases,the original site control situation,oligometastatic state,treatment methods,target treatment influence the prognosis of NSCLC with brain metastases(P<0.05),and on multivariate analysis,statistically significant prognostic factors included pathological type,radical surgery for the primary tumor,treatment methods,target treatment(P<0.05).However,gender,age,ZPS,metastasis interval,and symptoms of brain metastases were not found to be predictors of survival(P>0.05).3.178 patients were treated with Palliative therapy,surgery,chemotherapy,radiotheapy,chemoradiotherapy,comprehensive treatment of surgery-based,and the mOS was 3 months,9 months,14 months,12 months,19 months and 26 months respectively.4.Of 120 Patients had better PS score of 0 to 2,82 Patients with one to three brain metastases were treated with Surgery/? knife,WBRT,and Surgery/? knife+ WBRT;the mOS was 20 months,17 months,and 32 months respectively.Survival analysis showed that there was no statistical significance among the three groups(P=0.218).Compared with Surgery/? knife,Surgery/? knife+ WBRT failed to improve the survival statistically,but prolonged the mOS from 20.0 months to 32.0months.These patterns of therapy did not show difference among the three groups for multiple brain metastases.5.72 patients were treated as oligometastatic state.The combination therapy group did not show superiority compared with the systemic treatment group and the local treatment group(P>0.05),and the local treatment alone also no difference with the systemic treatment(P>0.05).Conclusion1.The independent predictors were pathological type,radical surgery for the primary tumor,treatment methods,target treatment.2.Compared with radiotherapy and chemotherapy,chemoradiotherapy prolonged the survival period,and the comprehensive treatment of surgery-based improved the OS compared with chemoradiotherapy significantly.3.In the absence of a difference in overall survival of Surgery/? knife+ WBRT and surgery/? knife alone for patients with 1 to 3 brain metastases and better ZPS,these findings suggest that Surgery/? knife alone may be a preferred strategy.4.Oligometastatic patients had better survival benefits than generalized metastases,but there were no statistical difference in treatment groups. |
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