摘要
目的探讨贝伐珠单抗联合伽玛刀治疗老年肺癌脑转移瘤的疗效及预后影响因素。方法回顾性分析2020年9月至2023年9月期间于铜川市人民医院治疗的178例老年肺癌脑转移瘤患者的病历资料,按照治疗方式将患者分为对照组(n=90)和研究组(n=88),对照组为伽玛刀治疗,并于治疗后给予脱水、激素等常规治疗,研究组在对照组治疗基础上联合贝伐珠单抗治疗,比较两组治疗效果、卡氏功能状态(KPS)评分、美国国立卫生研究院脑卒中量表(NIHSS)评分、免疫功能及不良反应,采用单因素及多因素Cox回归分析探讨老年肺癌脑转移瘤患者预后的影响因素。结果对照组的客观缓解率为52.22%(47/90)、疾病控制率为81.11%(73/90),明显低于研究组的77.27%(68/88)、92.05%(81/88)(P均<0.05)。治疗后,两组患者KPS评分升高、NIHSS评分降低,且研究组上述指标优于对照组(P<0.05)。治疗后,两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平升高,且研究组高于对照组(P<0.05)。两组患者不良反应总发生率无统计学差异(P>0.05)。178例老年肺癌脑转移瘤患者出院后连续随访1年,共有125例患者存活,1年总生存率为70.22%(125/178)。老年肺癌脑转移瘤患者的1年总生存率与年龄、脑转移病灶数目、病理类型、治疗方法、原发病控制情况、病灶累及小脑有关(P均<0.05);贝伐珠单抗联合伽玛刀治疗患者的1年总生存率高于伽玛刀治疗患者(P<0.05)。多因素Cox回归分析显示,脑转移病灶数目(HR=2.563,95%CI:1.429~4.596)、病理类型(HR=2.765,95%CI:1.674~4.567)、治疗方法(HR=2.298,95%CI:1.550~3.407)、原发病控制情况(HR=2.171,95%CI:1.246~3.780)、病灶累及小脑(HR=2.010,95%CI:1.138~3.548)是老年肺癌脑转移瘤患者预后的影响因素(P<0.05)。结论与伽玛刀治疗老年肺癌脑转移瘤比较,贝伐珠单抗联合伽玛刀的治疗效果更佳,可以明显改善患者KPS评分、NIHSS评分及免疫水平,且脑转移病灶数目、病理类型、治疗方法、原发病控制情况、病灶累及小脑是影响老年肺癌脑转移瘤患者治疗预后的关键因素。
Objective To investigate the efficacy and prognostic factors of bevacizumab combined with gamma knife in the treatment of brain metastases of elderly patients with lung cancer.Methods Case data of 178 elderly patients with lung cancer brain metastases treated in our hospital from September 2020 to September 2023 were retrospectively analyzed.The patients were divided into a control group(n=90)and a study group(n=88)according to the treatment methods.The control group received gamma knife treatment and conventional treatments such as dehydration and steroids after treatment.The study group received treatment with bevacizumab in addition to the control group's treatment.The treatment efficacy,Karnofsky functional status(KPS)score,National Institutes of Health Stroke Scale(NIHSS)score,immune function and toxic side effects of the two groups were analyzed.Univariate and multivariate Cox regression were made to explore the influencing factors of prognosis in elderly patients with lung cancer brain metastases.Results The objective remission rate and disease control rate of the control group were 52.22%(47/90)and 81.11%(73/90),which were lower than those of the study group(77.27%)(68/88)and 92.05%(81/88)(P<0.05).After treatment,the KPS scores of both groups of patients increased and the NIHSS scores decreased,and the above indicators in the study group were better than those in the control group(P<0.05).After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were increased,and the levels of the study group were higher(P<0.05).There was no significant difference in the total incidence of side effects between the two groups(P>0.05).The 1 year follow-up showed that a total of 125 patients survived,and the 1-year overall survival rate was 70.22%(125/178).The 1-year overall survival rate of elderly lung cancer patients with brain metastases was related to age,number of brain metastases,pathological types,treatment methods,primary disease control and cerebellar lesion involvement(all P<0.05).The 1-year overall survival rate of cases treated with bevacizumab combined with gamma knife was higher than that of patients treated with gamma knife only(P<0.05).The number of brain metastases(HR=2.563,95%CI:1.429-4.596),pathological type(HR=2.765,95%CI:1.674-4.567),treatment method(HR=2.298,95%CI:1.550-3.407),primary disease control(HR=2.171,95%CI:1.246-3.780),cerebellar lesion involvement(HR=2.010,95%CI:1.138-3.548)were the prognostic factors in elderly patients with lung cancer brain metastases(P<0.05).Conclusion Compared with the treatment of elderly lung cancer brain metastases only with gamma knife,the combination of bevacizumab and gamma knife has a better therapeutic effect,which can significantly improve the KPS score,NIHSS score,and immune level.The number of brain metastases,pathological type,treatment method,control of primary disease,and involvement of the cerebellum are key factors affecting the treatment prognosis of elderly lung cancer brain metastases.
作者
张妍妍
刘婧
郭小军
赵新汉
王斌锋
ZHANG Yanyan;LIU Jing;GUO Xiaojun;ZHAO Xinhan;WANG Binfeng(Department of Oncology,Tongchuan People's Hospital,Tongchuan,Shaanxi 727100,China;Department of Oncology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710061,China)
出处
《中华神经外科疾病研究杂志》
2025年第5期91-96,共6页
Chinese Journal of Neurosurgical Disease Research
基金
陕西省自然科学研究计划项目(2020JM-594)。
关键词
贝伐珠单抗
伽玛刀
肺癌脑转移瘤
老年患者
疗效
预后
bevacizumab
gamma knife
lung cancer brain metastases
elderly patients
curative effect
prognosis
