递归分割分析（RPA）分类法无法预测有四个或更多脑转移瘤患者的生存率。

Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases.

作者信息

Nieder Carsten, Andratschke Nicolaus, Grosu Anca L, Molls Michael

机构信息

Department of Radiotherapy and Radiologic Oncology, Klinikum rechts der Isar, Technical University of Munich, Germany.

出版信息

Strahlenther Onkol. 2003 Jan;179(1):16-20. doi: 10.1007/s00066-003-1028-x.

DOI:10.1007/s00066-003-1028-x

PMID:12540980

Abstract

BACKGROUND

We evaluated prognostic factors for survival in patients with four or more brain metastases in order to determine whether intense local treatment might be justified for some of them. If up to three brain metastases are present, surgical resection or radiosurgery are currently being considered in case of favorable prognostic factors.

PATIENTS AND METHODS

Retrospective intention-to-treat analysis of 113 patients who underwent whole-brain radiotherapy without surgical resection or radiosurgery at a single institution. Standard treatment was given with ten fractions of 3 Gy. Higher total doses were administered in 13% of patients. Recursive partitioning analysis (RPA) prognostic classes have been described by the Radiation Therapy Oncology Group (RTOG) in 1997 (class I: Karnofsky performance status [KPS] > or = 70%, age < or = 65 years, no extracranial metastases, controlled primary tumor; class III: KPS < 70%; class II: others).

RESULTS

Median number of brain metastases was six (four to 50). Most patients (69%) had extracranial metastases as well. Criteria of RPA Class I (II) were met in 4% (41%), whereas 56% had KPS < 70% and thus were grouped into class III (Tables 1 and 2). Complete or partial remission of brain metastases was found in 46% of patients who underwent computed tomography. Median survival was 4 months, 1-years survival rate 15%. Only age was a borderline significant prognostic factor in univariate analysis (< or = 50 years vs > 50 years, p = 0.05). Strong trends were found for KPS, extracranial metastases, control of the primary tumor, and breast primary tumor. Number of brain metastases, RPA class and treatment-related factors such as total dose or remission of brain metastases had no appreciable influence on survival (Figure 1). Multivariate analysis failed to identify any significant prognostic factor.

CONCLUSIONS

Patients with four or more brain metastases seem to represent a group with unfavorable prognosis where remission of brain metastases or administration of more than 30 Gy were not associated with increased survival. The number of patients in RPA class I was too small to draw final conclusions. However, there was absolutely no survival difference between patients in class II (median survival 3.6 months) and III (median 4.2 months).

摘要

背景

我们评估了有四处或更多脑转移瘤患者的生存预后因素，以确定对其中部分患者进行强化局部治疗是否合理。如果存在多达三处脑转移瘤，在具有有利预后因素的情况下，目前会考虑手术切除或立体定向放射治疗。

患者与方法

对在单一机构接受全脑放疗且未进行手术切除或立体定向放射治疗的113例患者进行回顾性意向性治疗分析。标准治疗为给予10次分割、每次3 Gy的放疗。13%的患者接受了更高的总剂量放疗。放射治疗肿瘤学组（RTOG）于1997年描述了递归分区分析（RPA）预后分类（I类：卡氏功能状态[KPS]≥70%，年龄≤65岁，无颅外转移，原发肿瘤得到控制；III类：KPS＜70%；II类：其他）。

结果

脑转移瘤的中位数为6处（4至50处）。大多数患者（69%）也有颅外转移。4%（41%）的患者符合RPA I（II）类标准，而56%的患者KPS＜70%，因此被归为III类（表1和表2）。接受计算机断层扫描的患者中，46%出现脑转移瘤完全或部分缓解。中位生存期为4个月，1年生存率为15%。单因素分析中，仅年龄是一个临界显著的预后因素（≤50岁与＞50岁，p = 0.05）。在KPS、颅外转移、原发肿瘤控制情况及乳腺原发肿瘤方面发现了明显趋势。脑转移瘤数量、RPA分类以及诸如总剂量或脑转移瘤缓解情况等治疗相关因素对生存无明显影响（图1）。多因素分析未能确定任何显著的预后因素。