The Analysis Of Prognostic Factors In Lung Cancer About Brain Metastases As The First Diagnosis And Last Brain Metastases

Part I Analysis of Prognostic Factors for71patients with brain Metastasisfrom Lung CancerObjective:In our country, the morbidity and mortality of lung cancer among the topof the malignant tumor, distant metastasis is one of the main reasons for lungcancer treatment failure, while brain metastases are common. After brainmetastasis, patient’s life quality is lower, and the survival time is shorter. Howto improve the life quality and survival time of patients with brain metastasesfrom lung cancer, become a clinical problem to be solved. So we reviewed theclinical data of71cases patients with brain metastases for diagnosis of lungcancer, and evaluate the influence of treatment methods (no treatment,radiotherapy, radiotherapy combined chemotherapy), gender, smoking history,RPA classification, lesions (single, or multiple), clinical symptoms, anemiaand pathological types on brain metastases as the first diagnosis from lungcancer survival, in order to provide theoretical basis for judging the prognosisand clinical treatment strategy.Methods:Retrospective analysis of clinical characteristics about71cases lungcancer patients with brain metastases for diagnosis of Chengde medicalcollege affiliated hospital oncology department from January2007toDecember2011. According to different treatments, were divided intountreated group concluding24cases, simple radiotherapy group concluding24cases, radiotherapy combined chemotherapy group concluding23cases,and telephone follow up the situation of survivals, and analyze the clinicaldata (gender, smoking history, RPA grading, brain metastatic lesions, clinicalsymptoms, anemia and pathological type, etc.), create a complete database, Use the SPSS17.0statistical software for statistical processing, Thecomparison of sample constituent ratio using x2test, and use Kaplan-Meiermethod to calculate median survival time and survival, draw curve, and use theLog-rank test to univariate analysis of treatment, gender, smoking history,RPA grading, lesions (single, multiple), clinical symptoms, anemia andpathological types, in order to compare the difference between survival rate,Cox proportional hazards regression model of single variable analysis wasstatistically significant variables, screened out of the various factors related tosurvival analysis. And the last, multivariate the prognosis analysis conductedby survival using a Cox proportional hazard regression model.Results:①The brain metastasis for diagnosis of patients from lung cancer,39cases of male (55%),32cases of women (45%);40cases (56%) with nosmoking history,31cases (44%) with smoking history;14cases (20%) ofRPA1,51cases (72%) of RPA2,6cases (8%) of RPA3; Brain metastaticlesions for single25cases (35%), multiple (≥2)46cases (65%);Asymptomatic patients with14cases (20%), and57patients with symptoms(80%);59cases(83%) of patients with no anemia,12cases (17%)had anemia;Small cell lung cancer17cases (24%), lung adenocarcinoma33cases (47%),lung squamous carcinoma in18cases (25%), and other3cases (4%); Notreatment group24cases (34%), simple radiotherapy group24cases (34%),radiotherapy combined chemotherapy group23cases (32%). The comparisonof sample composition ratio have no statistical difference (P>0.05), and everygroup data is comparable.②The overall1-,1.5-, and2-year survival rate was31.8%,16.4%,and4.8%, and with a median survival time of8.5months(95%CI6.08-10.92).The mean survival times were3.4months in the Untreatedgroup, and9.0months in the simple radiotherapy group,11.5months in theradiotherapy combined chemotherapy group(P=0.001). Radiotherapy andradiotherapy combined chemotherapy group’s MST is longer than untreatedgroup (P<0.05), while the radiotherapy compared with radiotherapy combinedchemotherapy group, MST has no obvious difference (P>0.05).③In univariate analysis and multivariate analysis, smoking history, RPA grading,anemia, and treatment method were independent prognostic factors (P<0.05),while gender, lesions, clinical symptoms, pathological type, has nothing to dowith the prognosis (P>0.05).Conclusion:Active treatment (radiotherapy or radiotherapy combined chemotherapy)can prolong survival time of lung cancer patients with brain metastases fordiagnosis. The main prognostic factors of brain metastasis from lung cancerare smoking history, RPA grading, anemia, and treatment method. Havesmoking history, RPA class for3, and with anemia when Diagnosis of brainmetastases are adverse prognostic factors for lung cancer patients with brainmetastases for diagnosis, the patients with poor prognosis.Part ⅡPrognostic analysis of86cases of brain metastases after lung cancerpatientsObjective:In our country, the morbidity and mortality of lung cancer among the topof the malignant tumor, distant metastasis is one of the main reasons for lungcancer treatment failure, while brain metastases are common. After brainmetastasis, patient’s life quality is lower, and the survival time is shorter. Howto improve the life quality and survival time of patients with brain metastasesfrom lung cancer, become a clinical problem to be solved. So we reviewed theclinical data of86cases of brain metastases after lung cancer patients, andevaluate the influence of treatment (not treatment, radiotherapy, radiotherapyplus chemotherapy), gender, smoking history, RPA classification, the numberof lesions (single, multiple), clinical symptoms, anemia, pathological type onshifting patient survival after brain cancer hair, in order to provide theoreticalbasis for judging the prognosis and clinical treatment strategy.Methods:To review the clinical characteristics of86cases from January2007toDecember2011in patients with brain metastases clinical data of lung cancer. according to different treatments, they were divided into untreated groupincluding24cases, simple radiotherapy group including32cases,radiotherapy combined chemotherapy group including30cases, and telephonefollow up the situation of survivals, and analyze the clinical data (gender,smoking history, RPA grading, brain metastatic lesions, clinical symptoms,anemia and pathological type, etc.), create a complete database, Use the SPSS17.0statistical software for statistical processing, The comparison of sampleconstituent ratio using x2test, and use the method of Kaplan Meier to calculatemedian survival time and survival, draw curve, and use the Log-rank test tounivariate analysis of treatment, gender, smoking history, RPA grading,lesions (single, multiple), clinical symptoms, anemia and pathological types,in order to compare the difference between survival rate, Cox proportionalhazards regression model of single variable analysis was statisticallysignificant variables, screened out of the various factors related to survivalanalysis. And the last, multivariate the prognosis analysis conducted bysurvival using a Cox proportional hazard regression model.Results:①The brain metastases after lung cancer patients,47cases of male(55%),39cases of women (45%);48cases (56%) with no smoking history,38cases (44%) with smoking history;26cases (30%) of RPA1,52cases (60%)of RPA2,8cases (10%) of RPA3; Brain metastatic lesions for single34cases (40%), multiple (≥2)52cases (60%); Asymptomatic patients with16cases (19%), and70patients with symptoms (81%);61cases(71%) of patientswith no anemia,25cases (29%)had anemia; Small cell lung cancer26cases(30%), lung adenocarcinoma42cases (49%), lung squamous carcinoma in14cases (16%), and other4cases (5%); No treatment group24cases (28%),simple radiotherapy group32cases (37%), radiotherapy combinedchemotherapy group30cases (35%). The comparison of sample compositionratio have no statistical difference (P>0.05), and every group data iscomparable.②The overall0.5-,1-, and2-year survival rate was47.7%,29.2%,and9.8%, and with a median survival time of6.0months (95%CI 4.38-7.62).The mean survival times were3.4months in the Untreated group,and3.5months in the simple radiotherapy group,15.5months in theradiotherapy combined chemotherapy group (P=0.001). Radiotherapycombined chemotherapy group’s MST is longer than untreated andRadiotherapy group (P<0.05), while the radiotherapy compared with untreatedgroup, MST has no obvious difference (P>0.05).③Smoking history（P=0.002）, anemia（P=0.004）, symptoms（P=0.002）, RPA grading(P=0.013), and treatment method（P=0.000）were independent prognosticfactors.Conclusion:Active treatment (radiotherapy combined chemotherapy) can prolongsurvival time of brain metastases after lung cancer patients. Smoking history,anemia, symptoms，RPA grading, and treatment method were independentprognostic factors. Have smoking history, RPA class for3, and with anemia orhave symptoms when Diagnosis of brain metastases are adverse prognosticfactors for brain metastases after lung cancer patients, the patients with poorprognosis. In addition, before, after, or in the treatment should be positivecorrection of anemia, can improve the quality life and prognosis of patients.