Lagerwaard F J, Levendag P C, Nowak P J, Eijkenboom W M, Hanssens P E, Schmitz P I
Department of Radiation Oncology, Daniel den Hoed Cancer Center, University Hospital Rotterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 1999 Mar 1;43(4):795-803. doi: 10.1016/s0360-3016(98)00442-8.
Prognostic factors in 1292 patients with brain metastases, treated in a single institution were identified in order to determine subgroups of patients suitable for selection in future trials.
From January 1981 through December 1990, 1292 patients with CT-diagnosed brain metastases were referred to the Department of Radiation Oncology, Daniel den Hoed Cancer Center, Rotterdam. The majority of patients were treated with whole brain radiotherapy (84%), the remainder were treated with steroids only or surgery and radiotherapy. Information on potential prognostic factors (age, sex, performance status, number and distribution of brain metastases, site of primary tumor, histology, interval between primary tumor and brain metastases, systemic tumor activity, serum lactate dehydrogenase, response to steroid treatment, and treatment modality) was collected. Univariate and multivariate analyses were performed to determine significant prognostic factors. Results were compared with literature findings using a review of prognostic factors in 18 published reports.
Overall median survival was 3.4 months, with 6-month, 1-year, and 2-year survival percentages of 36%, 12%, and 4% respectively. Survival was statistically significantly different between treatment modalities, with median survival of 1.3 months in patients treated with steroids only, 3.6 months in patients treated with radiotherapy, and 8.9 months in patients treated with neurosurgery followed by radiotherapy (p < 0.0001). Multivariate analysis confirmed literature findings of the major prognostic value of treatment modality on survival of patients with brain metastases. Performance status, response to steroid treatment, systemic tumor activity, and serum lactate dehydrogenase were independent prognostic factors with the strongest impact on survival, second only to treatment modality. Site of primary tumor, age, and number of brain metastases were also identified as prognostic factors in our material, although with lesser importance. In patients with lung primaries, sex was found to have significant impact on survival. In patients with breast primaries, interval between primary tumor and development of brain metastases appeared to be a statistically significant prognostic factor. Histology in patients with lung primaries and distribution of brain metastases were not found to be statistically significant in multivariate analysis.
In this large database, the value of established prognostic factors was confirmed and, furthermore, some less well-recognized parameters such as response to steroid treatment, serum lactate dehydrogenase, age, sex in lung primaries, and site of primary tumor were established. From the three strongest prognostic factors--performance status, response to steroids, and evidence of systemic disease--simple identification of favorable and unfavorable subgroups of patients with brain metastases can be constructed.
确定在单一机构接受治疗的1292例脑转移瘤患者的预后因素，以便确定适合未来试验入选的患者亚组。
1981年1月至1990年12月，1292例经CT诊断为脑转移瘤的患者被转诊至鹿特丹丹尼尔·登霍德癌症中心放射肿瘤学系。大多数患者接受了全脑放疗（84%），其余患者仅接受了类固醇治疗或手术及放疗。收集了有关潜在预后因素的信息（年龄、性别、体能状态、脑转移瘤的数量和分布、原发肿瘤部位、组织学类型、原发肿瘤与脑转移瘤之间的间隔时间、全身肿瘤活性、血清乳酸脱氢酶、对类固醇治疗的反应以及治疗方式）。进行单因素和多因素分析以确定显著的预后因素。通过回顾18篇已发表报告中的预后因素，将结果与文献中的发现进行比较。
总体中位生存期为3.4个月，6个月、1年和2年生存率分别为36%、12%和4%。不同治疗方式的生存率在统计学上有显著差异，仅接受类固醇治疗的患者中位生存期为1.3个月，接受放疗的患者为3.6个月，接受神经外科手术加放疗的患者为8.9个月（p<0.0001）。多因素分析证实了文献中的发现，即治疗方式对脑转移瘤患者的生存具有主要预后价值。体能状态、对类固醇治疗的反应、全身肿瘤活性和血清乳酸脱氢酶是独立的预后因素，对生存的影响最大，仅次于治疗方式。原发肿瘤部位、年龄和脑转移瘤数量在我们的研究资料中也被确定为预后因素，尽管重要性稍低。在原发肿瘤为肺癌的患者中，性别对生存有显著影响。在原发肿瘤为乳腺癌的患者中，原发肿瘤与脑转移瘤发生之间的间隔时间似乎是一个具有统计学意义的预后因素。在多因素分析中，原发肿瘤为肺癌患者的组织学类型和脑转移瘤的分布无统计学意义。
在这个大型数据库中，已确立的预后因素的价值得到了证实，此外，还确立了一些不太为人所知的参数，如对类固醇治疗的反应、血清乳酸脱氢酶、年龄、原发肿瘤为肺癌时的性别以及原发肿瘤部位。根据三个最强的预后因素——体能状态、对类固醇的反应和全身疾病的证据——可以构建出脑转移瘤患者的有利和不利亚组的简单识别方法。
