| Objective: The purpose of this subject is to explore the prognostic impact of peritumoral edema and different radiotherapy intervention timing on non-small cell lung cancer patients with brain metastases.Through retrospective analysis of 146 cases of non-small cell lung cancer patients with brain metastases admitted to our hospital in recent years,the effect of peritumoral edema and brain radiotherapy timing on the prognosis of NSCLC patients with brain metastases is discussed.Methods:146 patients with non-small cell lung cancer(NSCLC)and brain metastases(BM)admitted to our hospital from January 1,2014 to October 1,2018 were included in this study.The subjects of the study were patients with complete medical records and regular follow-up visits.All patients were diagnosed as non-small cell lung cancer with brain metastases by clinical imaging and pathological examination.All the patients were treated in our hospital according to relevant regulations.The data of sex,age,survival time after initial diagnosis,EGFR gene status,Time of occurrence of brain metastases,time of survival after brain metastases,Diagnosis of brain metastases,time interval between brain metastases and the beginning of brain radiotherapy,control of primary tumour,extracranial metastases,location of brain metastases,size of brain metastases,brain edema,maximum diameter of brain metastases,number of brain metastases data were collected.Patients are divided into peritumoral edema group and non-peritumoral edema group according to the presence or absence of peritumoral edema,or into early radiotherapy group and late radiotherapy group according to the different time of radiotherapy.Logistic regression was used to analyze the relevant factors affecting the survival time of NSCLC with brain metastasis.Kaplan-Meier method was used for survival calculation,Log-Rank test was used for significance analysis.The difference was statistically significant with P < 0.05.the survival difference with or without peritumoral edema and different radiotherapy intervention timing and the prognostic influencing factors of NSCLC brain metastases were discussed respectively.Results: the 3-month,6-month,and 1-year survival rate(92.0%,72.0%,44.0%)of patients without peritumoral edema was higher than that of patients with peritumoral edema(58.3%,41.7%,18.8%),The 3-month,6-month and 12-month survival rates of the two groups were significantly different(P < 0.05).the 3-month,6-month,1-year survival rates of the patients in the early radiotherapy group(75.0%,54.2%,50.0%)were higher than those in the late radiotherapy group(59.4%,34.4%,18.8%).the 3-month survival rates of the two groups were not significantly different(P > 0.05).However,the difference in total survival time of 6 months and 1 year is statistically significant(all p < 0.05).the median survival time of patients with peritumoral edema after brain metastasis is 5 months,and that of patients without peritumoral edema is 12 months.the median survival time of patients with peritumoral edema is shorter and the prognosis is worse than that of patients without peritumoral edema.the difference is statistically significant(P < 0.05).the median survival time of patients in the early radiotherapy group after brain metastasis is 19 months,and that of patients in the late radiotherapy group is 4 months.the median survival time of patients in the late radiotherapy group is shorter and the prognosis is worse than that of patients in the early radiotherapy group.the difference is statistically significant(P < 0.05).Taking the survival time of patients over 1 year as dependent variable,the cases were divided into death group and survival group for single factor analysis.there were significant differences between death group and survival group in gender,smoking,brain edema,time between brain metastasis and radiotherapy,number of brain metastases,control of primary tumour in brain metastasis site and whether extracranial metastasis existed,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that brain edema,the interval between brain metastasis and radiotherapy was more than 3 months(late radiotherapy),the number of brain metastases was more than 3,brain stem was included in brain metastasis site,and the progression of primary lesion were independent risk factors affecting the survival time of patients.The difference was statistically significant(P > 0.05).Conclusion: Patients with peritumoral edema have shorter survival time and poorer prognosis than patients without peritumoral edema,and patients with late radiotherapy have shorter survival time and poorer prognosis than patients with early radiotherapy.Peritumoral edema and the timing of radiotherapy are closely related to the survival of NSCLC brain metastases. |
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