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Objective:To investigate the effect of peripheral blood neutrophil-to-lymphocyte ratio (NLR) before radical radiotherapy on overall survival (OS) of patients with esophageal squamous cell carcinoma.Methods:The clinical data of 359 patients with esophageal squamous cell carcinoma from March 2011 to January 2017 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The gender, age, smoking index, Karnofsky score, lesion site, lesion length, tumor length, TNM stage, concurrent chemoradiotherapy, NLR, etc., were observed. Receiver operating characteristic (ROC) curve was drawn according to patients' NLR to find the optimal cut-off value, the patients were divided into the low NLR group and the high NLR group, and the OS of the two groups was analyzed. Univariate log-rank test and multivariate Cox analysis were used to determine the factors affecting the OS of patients.Results:The area under the curve (AUC) of NLR for predicting OS was 0.576, the best cut-off value for OS prediction was 2.103 6, and the sensitivity and specificity were 60.8% and 55.2%, respectively. According to the best cut-off value of peripheral blood NLR 2.103 6, the 359 patients were divided into the low NLR group (NLR < 2.103 6, 156 cases, 43.5%) and high NLR group (NLR ≥ 2.103 6, 203 cases, 56.5%). There were statistical differences in gender ( χ2 = 8.960, P = 0.003) and lesion length ( χ2 = 12.948, P = 0.002) between low NLR group and high NLR group. Univariate analysis showed that the lesion length, NLR, N stage, M stage and total TNM clinical stage were influencing factors affecting OS of patients (all P < 0.05). Multivariate Cox regression analysis showed that the lesion length ( HR = 1.456, 95% CI 1.215-1.745, P < 0.01), NLR ( HR = 1.313, 95% CI 1.020-1.690, P = 0.035) and N stage ( HR = 1.768, 95% CI 1.391-2.248, P < 0.01) were independent influencing factors affecting OS of patients with esophageal squamous cell carcinoma before radical radiotherapy. Conclusions:Peripheral blood NLR is an independent influencing factor affecting OS of esophageal squamous cell carcinoma patients before radical radiotherapy. NLR has important reference value for predicting the OS of patients with esophageal squamous cell carcinoma after radical radiotherapy.
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Objective To explore the effect of prognostic nutrition index (PNI) on the overall survival time of patients with brain metastases of lung adenocarcinoma.Methods A retrospective analysis was performed on the clinic data of 274 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma from May 2013 to May 2016.The prognosic factors for brain metastases such as PNI,gender,age,smoking history,epidermal growth factor receptor (EGFR) mutation status,Karnofsky performance status (KPS) score,the number of brain lesions,treatment of brain lesions,extracranial metastases and the status of primary disease were analyzed.The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of PNI,and the patients were divided into high PNI group and low PNI group.The univariate and multivariate prognostic analyses were performed by the Log-rank test and the Cox proportional hazards model.Results The patients were divided into high PNI (＞ 50.45) group (n =72) and low PNI (≤50.45) group (n =202).The median overall survival (OS) was 11.20 months in all patients with brain metastases,and the median OS of the low PNI group and high PNI group were 10.13 months and 15.17 months respectively.The univariate analysis results showed that gender (x2 =5.459,P =0.019),age (x2 =3.986,P =0.046),smoking or not (x2 =6.878,P =0.009),EGFR mutation status (x2 =20.484,P＜0.001),KPS score (x2 =126.573,P ＜ 0.001),extracranial metastases or not (x2 =4.403,P =0.036),treatment on the brain lesions (x2 =40.444,P ＜ 0.001) and PNI (x2 =7.972,P =0.005) were related to the prognosis.The Cox multivariate analysis results showed that age (HR =1.580,95％ CI:1.104-2.295,P =0.012),EGFR mutation status (HR =0.549,95％ CI:0.408-0.738,P ＜ 0.001),KPS score (HR =0.077,95％CI:0.045-0.134,P ＜ 0.001),treatment on brain metastases (HR =0.882,95％ CI:0.789-0.987,P =0.029) and PNI (HR =0.614,95％ CI:0.437-0.861,P =0.005) were related to the prognosis.Conclusion PNI is an independent prognostic predictor of brain metastases in patients with lung adenocarcinoma,and the high-PNI is correlated to the long OS of patients with brain metastases of lung adenocarcinoma,which has certain clinical practical value.
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Objective To explore the incidence of brain metastases from esophageal cancer,survival-related factors after brain metastases,and the result of different treatment methods.Methods From January 2000 to October 2016 treated 11 338 cases of esophageal cancer patients,84 cases of brain metastases,were collected with complete clinical data.Results Eighty four cases of patients with brain metastases included esophageal squamous carcinoma in 74 cases,adenocarcinoma in 6 cases,and small cell undifferentiated carcinoma 4 cases;single brain metastases in 19 cases,65 cases of multiple brain metastases included 59 cases with brain metastasis symptoms,58 with extracranial metastases,primary tumors and brain metastases interval time less than 6 months in 31 cases,24 cases of 6-12,16 cases for 12-24 months.Prognostic logrank univariate analysis of survival rate found 24-36 months survival for 13 patients.All patients were followed for a median of 19.31 months after brain metastases,the median survival time was 5.43 months.Conclusions About 0.7％ of brain metastases from esophageal cancer occurs.Esophageal carcinoma metastatic to the brain:There was no extracranial metastasis,recursive partitioning analysis classification (RPA),Karnofsky (KPS) score,brain metastases different treatment methods is a poor prognostic factor for esophageal cancer brain metastasis.
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Objective@#To investigate the relationship between the status of epidermal growth factor receptor (EGFR) mutations and brain metastases in patients with lung adenocarcinoma.@*Methods@#From August 2010 to May 2015, a total of 1 063 lung adenocarcinoma patients with identified status of EGFR mutations in Shanxi Cancer Hospital were enrolled, of which 456 patients had EGFR mutations. Multivariate Logistic regression model was used to analyze the correlation between EGFR mutation status and brain metastases in patients with lung adenocarcinoma.@*Results@#In 125 patients with brain metastases before initial treatment, 65 patients had EGFR mutations, including 36 patients with deletion mutations in exon 19. The frequency of EGFR 19 exon mutation was 28.8% (36/125). Among 456 patients with EGFR mutations, 65(14.3%) patients were with brain metastases, in which 36(55.0%) had deletion mutations in exon 19. The multivariate analysis showed that age, Eastern Cooperative Oncology Group (ECOG) score, EGFR mutations and N staging were associated with brain metastases(P<0.05). Further subgroup multivariate analyses showed that age, ECOG score, mutation status in exon 19 and N staging were associated with brain metastases (P<0.05).@*Conclusions@#EGFR mutation status is related to brain metastases. Mutations in EGFR exon 19 is an independent risk factor for brain metastases.
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Objective To explore the association between epidermal growth factor receptor (EGFR) mutation subtypes and the prognosis of brain metastasis in patients with lung adenocarcinoma.Methods A retrospective analysis was performed on the clinical data of 256 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma by EGFR mutation detection from 2010 to 2015.The prognostic factors for brain metastases were analyzed.The survival rate was calculated by the Kaplan-Meier method and analyzed by the log-rank test.The univariate and multivariate prognostic analyses were performed by the log-rank test and the Cox proportional hazards model.Results The median survival time was 10.13 months in all patients.The univariate analysis showed that sex,EGFR mutation status,exon 19 deletion,the Karnofsky Performance Status (KPS) score of brain metastases,and targeted therapy were prognostic predictors (P=0.006,0.001,0.010,0.000,0.003).The multivariate analysis showed that the KPS score and exon 19 deletion were prognostic factors for brain metastases (P=O.000,0.045).When grouped into the recursive partitioning analysis classes,all the patients were split into three subgroups with significantly different prognosis (P =0.000).Conclusions Exon 19 deletion is a prognostic predictor of brain metastases in patieuts with lung adenocarcinoma,which can be integrated into the prognosis scoring system for brain metastases of lung adenocarcinoma.EGFR tyrosine kinase inhibitors improve the survival in patients with brain metastases of lung adenocarcinoma and EGFR mutation,particularly,in those with exon 19 deletion.
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Objective To compare the clinical effect of whole brain radiotherapy (WBRT) for brain metastases from lung adenocarcinoma between patients with and without epithelial growth factor receptor (EGFR) mutations.Methods A retrospective analysis was performed for 89 patients with brain metastases from lung adenocarcinoma who were treated in our hospital from August 2010 to May 2015.EGFR testing was performed in all patients.WBRT (6-MV external X-ray beam) was performed at 30 Gy in 10 fractions or 40 Gy in 20 fractions;for patients with ≤3 brain metastases, simultaneous integrated boost intensity-modulated radiotherapy was performed at 40-45 Gy in 10 fractions or 50-60 Gy in 20 fractions.The response rate, intracranial progression-free survival (IPFS), and overall survival (OS) were compared between patients with EGFR mutations and patients with wild-type EGFR.The Kaplan-Meier method was used to calculate IPFS and OS, the log-rank test was used for survival difference analysis and univariate prognostic analysis, and the Cox model was used for multivariate prognostic analysis.Results For these 89 patients, the overall response rate was 62%, the median IPFS was 7.0 months (95%CI:6.060-7.940), and the median OS was 12.0 months (95%CI:9.539-14.465).The univariate and multivariate analyses showed that the response rate was associated with Karnofsky Performance Scale (KPS) score and EGFR mutation status (P=0.009 and 0.035);KPS score and EGFR mutation status were significant prognostic factors for IPFS (P=0.048 and 0.000);KPS score and primary tumor control were significant prognostic factors for OS (P=0.000 and 0.031).Conclusions After WBRT for brain metastases from lung adenocarcinoma, the patients with EGFR mutations have a higher response rate and a longer IPFS compared with those with wild-type EGFR, but there is no significant in OS between the two groups of patients.
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Objective To explore the incidence of brain metastases from esophageal cancer,survival-related factors after brain metastases,and the result of different treatment methods.Methods From January 2000 to October 2016 treated 11 338 cases of esophageal cancer patients,84 cases of brain metastases,were collected with complete clinical data.Results Eighty four cases of patients with brain metastases included esophageal squamous carcinoma in 74 cases,adenocarcinoma in 6 cases,and small cell undifferentiated carcinoma 4 cases;single brain metastases in 19 cases,65 cases of multiple brain metastases included 59 cases with brain metastasis symptoms,58 with extracranial metastases,primary tumors and brain metastases interval time less than 6 months in 31 cases,24 cases of 6-12,16 cases for 12-24 months.Prognostic logrank univariate analysis of survival rate found 24-36 months survival for 13 patients.All patients were followed for a median of 19.31 months after brain metastases,the median survival time was 5.43 months.Conclusions About 0.7％ of brain metastases from esophageal cancer occurs.Esophageal carcinoma metastatic to the brain:There was no extracranial metastasis,recursive partitioning analysis classification (RPA),Karnofsky (KPS) score,brain metastases different treatment methods is a poor prognostic factor for esophageal cancer brain metastasis.
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Objective To discuss dosimetric advantage,compliance,efficacy and prognostic factors of whole brain conformal intensity-modulated radiotherapy ( IMRT ) combined with synchronous dosage for treatment of brain metastases.Methods Forty-one patients with metastatic tumor to the brain were confirmed by computed tomography (CT) or magnetic resonance imaging (MRI).They received whole brain irradiation and simultaneous integrated boost to bulky metastases by IMRT.Gross tumor volume(GTV) DT 4994-6990 cGy/ 22-30 fractions/4.4-6.0 weeks,whole brain DT 3990-5000 cGy/22-30 fractions/4.4-6.0 weeks.Results The median follow-up time was 6.4 months.The overall response rate,the median survival time and the overall survival at 1 year were 65.8 ％,8 months,24.4 ％.The brain-stem,spinalcord,lens,opticnerves were in the limited dose.In 21 patients,radioactive brain edema was happened,the rest did not appear early and late radiation reaction.Conclusion Whole brain irradiation using simultaneous integrated boost to bulky lesion by IMRT show an improvement in dose distribution and significant effect to patients with brain metastases.The therapy is well-tolerated and effective.