European Radiology:确诊肺癌后,是否存在脑转移?影像学有话说

2021-12-28 shaosai MedSci原创

脑转移是非小细胞肺癌(NSCLC)的常见并发症,在病程中的总发生率为40%,在最初诊断时的发生率为15-20%。

脑转移是非小细胞肺癌NSCLC)的常见并发症,在病程中的总发生率为40%,在最初诊断时的发生率为15-20%。脑转移预示着不良的预后在NSCLC患者中意义重大,据报道生存期为5-18.9个月。

目前,对新诊断的NSCLC患者进行脑部成像的适应症是基于临床分期。美国国家综合癌症网络建议临床分期为II至IV期的患者进行脑部磁共振成像(MRI),而美国癌症联合委员会(AJCC)第八版将其限制在临床III和IV期。鉴于这两个指南之间的差异,以及即使在NSCLC的早期阶段也会发生脑转移,因此建立一个优于临床分期的风险预测模型意义重大

近日,发表在European Radiology杂志的一项研究在新诊断的NSCLC患者中,根据病变的可切除性进行二分法评估,从分期胸部CT和临床特征中找出可评估脑转移的预测因素为临床的准确分期及个性化治疗方案的制定提供参考依据

本研究将2017年11月至2018年10月期间新诊断为临床II-IV期的NSCLC患者入组,根据胸部CT分为可切除期(II+IIIA期)和不可切除期(IIIB/C+IV期)。使用逻辑回归分析了临床病理特征和CT结果与脑转移的关联。使用受试者工作特性曲线分析对预测模型进行了评估。对有已知表皮生长因子受体基因(EGFR)突变状态的不可切除阶段患者进行了亚组分析。 

这项研究包括911名NSCLC患者(平均年龄,65±11岁;620名男性),其中194名患者被诊断为脑转移。对于可切除的阶段,脑转移的独立预测因素是N2阶段(25名患者中的13名)没有空气-支气管/空泡征(25名患者中的23名)以及存在毛刺征(25名患者中的15名),结合这两个成像特征的模型显示AUC为0。 在不可切除的阶段,脑转移的独立预测因素是年轻、女性、胸外转移和腺癌,结合这些因素的模型显示AUC为0.675-0.766。在已知EGFR突变状态的亚组中,胸外转移和EGFR突变阳性是脑转移的独立预测因素,模型显示AUCs为0.641-0.732。 

 a 轴位增强CT图像显示右上叶一77毫米的肿块,边缘呈分叶状。b 纵隔窗显示胸腔积液,胸膜结节状增厚(箭头),表明有胸膜转移。 c 纵隔窗设置下的冠状显示右肺和右气管旁的肿大淋巴结(箭头)。综合来看,患者的临床分期为T4、N2和M1a。用于分期的脑部MRI检查对脑转移是阴性的。

本研究表明,CT衍生的影像学特征和临床分期、肺癌亚型和EGFR突变是新诊断的NSCLC患者脑转移的预测因素,根据肿瘤的可切除性表现出不同的关联。纳入这些特征的预测模型可作为脑转移的风险预测模型

原文出处

Sohee Park,Sang Min Lee,Yura Ahn,et al.Identification of predictors for brain metastasis in newly diagnosed non-small cell lung cancer: a single-center cohort study.DOI:10.1007/s00330-021-08215-y

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    2022-04-16 feather89
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    2021-12-29 豪杰克

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    2021-12-29 查查佳佳

    2021年12月25日至26日是全国硕士研究生招生考试时间。

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