中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (3): 162-169. doi: 10.3969/j.issn.1672-6731.2021.03.007

• 神经外科疾病大数据 • 上一篇    下一篇

2 脑转移瘤患者单纯手术治疗与手术联合术后脑部放疗对比分析

王月坤, 刘磊, 陈琬琦, 王裕, 马文斌   

  1. 100730 中国医学科学院 北京协和医学院 北京协和医院神经外科
  • 收稿日期:2021-03-08 出版日期:2021-03-25 发布日期:2021-04-02
  • 通讯作者: 王裕,Email:ywang@pumch.cn

Comparison of neurosurgery combined brain radiotherapy versus neurosurgery alone for patients with brain metastases

WANG Yue-kun, LIU Lei, CHEN Wan-qi, WANG Yu, MA Wen-bin   

  1. Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2021-03-08 Online:2021-03-25 Published:2021-04-02

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摘要：

目的 总结脑转移瘤单纯手术和手术联合术后脑部放疗的治疗经验，并筛查此类患者放疗获益的相关影响因素。方法 纳入北京协和医院脑转移瘤数据库中2011年1月1日至2018年12月31日的成人脑转移瘤患者141例，根据不同治疗方案分为单纯手术组（91例）和手术联合术后脑部放疗组（联合治疗组，50例），收集性别、年龄、脑转移瘤数目和部位、神经系统症状、颅外转移、治疗方案等临床资料，绘制Kaplan-Meier生存曲线，并通过亚组分析、单因素log-rank检验和多因素Cox回归分析筛查预后相关影响因素，构建预后评分系统。结果 原发肿瘤主要为非小细胞肺癌和乳腺癌，以单发脑转移瘤、单纯幕上肿瘤、存在神经系统症状为主。与单纯手术组相比，联合治疗组原发肿瘤局部治疗比例较高（P=0.018），中位生存期较长（P=0.009）。多因素Cox回归分析显示，女性（RR=0.209，95% CI：0.077~0.567；P=0.002）、年龄≥ 65岁（RR=2.994，95% CI：1.066~8.411；P=0.037）、原发肿瘤为非小细胞肺癌（RR=0.175，95% CI：0.062~0.496；P=0.001）、脑转移瘤位于幕下（RR=0.065，95% CI：0.009~0.462；P=0.006）以及同时位于幕上和幕下（RR=0.130，95% CI：0.020~0.864；P=0.035）是患者生存预后的影响因素。根据上述结果构建预后评分系统，对于评分> 4的患者，联合治疗组中位生存期长于单纯手术组（P=0.023）。结论 手术联合术后脑部放疗可使脑转移瘤患者生存获益；女性、年龄≥ 65岁、原发肿瘤为非小细胞肺癌、幕下肿瘤是患者生存预后的影响因素；预后评分系统>4的患者推荐手术联合术后脑部放疗，评分≤4的患者可根据个体情况决定单纯手术或手术联合术后脑部放疗。

关键词: 肿瘤转移, 脑肿瘤, 转移瘤切除术, 放射疗法, 预后, 存活率分析

Abstract:

Objective To summarize the single-center experience on neurosurgery and neurosurgery combined radiotherapy of brain metastases, and determine factors for prolonged survival time after brain radiotherapy for patients undergoing neurosurgery for brain metastases. Methods A total of 141 adult patients diagnosed with brain metastases between January 1st, 2011 and December 31st, 2018 were included in this retrospective study, and were divided into neurosurgery group (n=91) and neurosurgery combined radiotherapy group (n=50). Clinical data, including patients' age, sex, diagnosis type of primary tumor, neurological symptoms, number and location of brain metastases, plans of brain treatment, systematic treatment and status of extracranial metastasis (ECM), were extracted retrospectively. Survival analysis, subgroup analysis and univariate log-rank and multivariate Cox analysis were applied to predict factors and prognosis scores. Results The major primary tumor types were non-small cell lung cancer and breast cancer. The patients included mainly had single and supratentorial lesions and neurological symptoms. The neurosurgery combined radiotherapy group had a statistically higher rate of local treatment of primary tumor (P=0.018). Multivariate Cox analysis showed that female (RR=0.209, 95%CI:0.077-0.567; P=0.002), age ≥ 65 years (RR=2.994, 95%CI:1.066-8.411; P=0.037), non-small cell lung cancer (NSCLC; RR=0.175, 95%CI:0.062-0.496, P=0.001) and infratentorial tumor (RR=0.065, 95%CI:0.009-0.462; P=0.006) or supratentorial plus infratentorial metastases (RR=0.130, 95%CI:0.020-0.864; P=0.035) were associated with prognosis. Compared with neurosurgery group, neurosurgery combined radiotherapy group had significantly prolonged median survival time (13.9 months vs. 21.9 months, P=0.009). The prognosis score was defined accordingly:for patients with a prognosis score > 4, those in neurosurgery combined radiotherapy group had a significantly prolonged survival time (29.6 months vs. 13.9 months, P=0.023). Conclusions For patients with brain metastases, neurosurgery combined with radiotherapy can prolong survival time and female, age < 65 years, NSCLC and infratentorial tumor are associated with better prognoses. A prognosis score was defined in our study, whereby neurosurgery combined radiotherapy is recommended for post-operative patients with a prognosis score > 4. For patients with a prognosis score ≤ 4, local management should be designed on an individual basis.

Key words: Neoplasm metastasis, Brain neoplasms, Metastasectomy, Radiotherapy, Prognosis, Survival analysis

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