| Objective: To explore the prognostic factors of patients with brain metastasis of small cell lung cancer,so as to provide reference for the formulation of clinical measures.Methods: In this study,60 patients with brain metastases who were initially diagnosed with limited-stage small cell lung cancer after treatment in the Department of Radiotherapy and Respiratory Medicine of Linyi Cancer Hospital from January 2014 to December 2020 were selected as the research subjects.Histopathologically confirmed.This study is a retrospective study: 1.Detailed records of age,gender,smoking index,KPS score at the time of diagnosis of small cell lung cancer,location of primary tumor,central/peripheral type,number of craniocerebral lesions,combined chest radio therapy,The time from lung cancer diagnosis to brain metastases,the concomitant metastases in other parts of the brain,the symptoms of brain metastases,and the control of the primary lesions were discussed in groups.2.Before the occurrence of brain metastases,patients should be given concurrent or consecutive thoracic radiotherapy combined with chemotherapy for 4-6 phases,and those who refuse radiotherapy should be given 4-6 phases of systemic chemotherapy;cranial radiotherapy should be added after the diagnosis of brain metastasis.3.End point and follow-up: Primary end point: overall survival;Secondary endpoint: BMSfree survival.Follow-up time: 1 time in the first 2 years and 3 months,1time in the following 3 years and 6 months,and 1 time in the following 1year,until the onset of brain metastases and death.The date of diagnosis was taken as the start time of follow-up,and the last follow-up was on October 31,2021.Follow-up patients with chest CT,cranial MRI,survival status,symptoms of brain metastases.4.SPSS 19.0 software was used for statistical analysis.Univariate Cox proportional hazards regression model was used to evaluate the relationship between clinicopathological characteristics and treatment methods and OS.Multivariate Cox proportional hazards regression model was used to analyze independent prognostic factors and multiple factors.Results: 1.Clinical data of 60 patients: 47 male patients（78.33%）and13 female patients（21.67%）,the age ranged from 43 to 79 years old,and the median age was 62 years old.There were 25 cases（41.67%）with chemotherapy alone,35 cases（58.33%）with chemotherapy combined with thoracic radiotherapy;18 cases（30.00%）with asymptomatic brain metastases,and 42 cases（70.00%）with symptomatic brain metastases;KPS at the time of diagnosis 33 patients（55.00%）with ≤70 patients,27patients（45.00%）with KPS > 70;38 patients（63.33%）with brain metastases ≥ 4,and 22 patients with brain metastases <4（36.67 %）;34cases（56.67%）in the right lung and 26 cases（43.33%）in the left lung in the primary tumor location;37 cases（61.67%）are central type and 23cases（38.33%）are peripheral type.Among all the cases,41 patients developed brain metastasis within 1 year,the rate of brain metastasis within1 year was 68.33%,56 patients with brain metastasis within 2 years,the rate of brain metastasis within 2 years was 93.33%,and 59 patients with brain metastasis within 3 years,The 3-year brain metastasis rate was98.33%.The median OS of patients was 22 months,1-year OS was 71.67%,2-year OS was 45.00%,and 3-year OS was 20.00%.2.The results of univariate analysis adding prognostic factors were as follows: the overall median OS of 60 patients was 22 months,and the median OS was significantly shorter in men than in women（20 vs 32;P=0.016）,and KPS was greater than 70 points at the time of diagnosis of small cell lung cancer.The OS of patients with ≤ 70 points was significantly longer（30 vs 18;P=0.004）,and the OS of patients with combined thoracic radiotherapy was significantly longer than that of patients with chemotherapy alone（26 vs15;P=0.029）.The time from lung cancer diagnosis to brain metastasis was> 9 The OS of patients with ≤9 months was significantly longer than that of ≤ 9 months（28 vs 19;P=0.016）,and the OS of patients without metastases to other parts of the brain was significantly longer than that of patients with metastases（26 vs 18;P=0.005）,no Patients with symptoms of brain metastases had significantly longer OS than those with symptoms of brain metastases（35 vs 19;P=0.031）,and patients with primary disease control had significantly longer OS than those without control（26 vs15;P=0.021）.Gender,age,smoking index,location of primary tumor,central type/peripheral type,number of brain metastasse and other factors had no significant effect on the prognosis of patients.3.The results of multivariate analysis adding prognostic factors are as follows: KPS at the time of diagnosis of small cell lung cancer（HR=1.556,95%CI:1.163～2.881,P=0.014）,combined with thoracic radiotherapy（HR=2.501,95%CI: 1.225～3.059,P=0.005）and the time from lung cancer diagnosis to brain metastasis（HR=1.615,95%CI: 1.003-2.625,P=0.036）were independent prognostic factors for the prognosis of limited-stage SCLC with brain metastasis.Conclusions: 1.Women,chemotherapy combined with thoracic radiotherapy,lung cancer diagnosis to brain metastases > 9 months,patients with no metastases to other sites except brain metastases,asymptomatic patients with brain metastases,KPS score > 70 points,and patients with primary tumor control survive period was significantly prolonged.2.KPS ≤70,chemotherapy alone,the time from lung cancer diagnosis to brain metastasis≤ 9 months were poor prognostic factors for patients with brain metastases after limited-stage small cell lung cancer treatment. |
