Burt M, Wronski M, Arbit E, Galicich J H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y. 10021.
J Thorac Cardiovasc Surg. 1992 Mar;103(3):399-410; discussion 410-1.
The treatment of patients with a solitary brain metastasis has been evolving, with most centers recommending resection in patients with good performance status. To evaluate the results of resection of brain metastases from non-small-cell lung cancer, we reviewed our 16-year experience with 185 consecutive patients undergoing resection of brain metastases from 1974 to 1989, inclusive. There were 89 men and 96 women; ages ranged from 34 to 75 years (median 54). Sixty-five (35%) had synchronous and 120 (65%) metachronous brain metastases. Discounting the brain metastasis, 68 patients (37%) had stage I, 13 (7%) stage II, 62 (33%) stage IIIA, 30 (16%) stage IIIB, and 12 (6%) stage IV carcinoma. There was no significant difference in age, locoregional stage (TN), or histologic features in patients with synchronous versus metachronous lesions. The overall survival rates (n = 185) were as follows: 1 year, 55%; 2 years, 27%; 3 years, 18%; 5 years, 13%; and 10 years, 7% (median 14 months). There was no significant difference in survival between patients with synchronous and metachronous lesions. To evaluate the impact of locoregional stage and treatment of the primary site, we analyzed only those patients with synchronous brain metastases. Multivariate analysis demonstrated that locoregional stage had no significant effect on survival (p = 0.97), but complete resection of the primary disease significantly prolonged survival (p = 0.002). Therefore complete resection, and not stage, of the locoregional primary lesion is the primary determinant of survival in patients undergoing resection of brain metastases from non-small-cell lung cancer.
孤立性脑转移瘤患者的治疗方法一直在不断发展，大多数中心建议身体状况良好的患者进行手术切除。为了评估非小细胞肺癌脑转移瘤切除术的效果，我们回顾了1974年至1989年（含）期间连续185例接受脑转移瘤切除术患者的16年治疗经验。其中男性89例，女性96例；年龄在34岁至75岁之间（中位数为54岁）。65例（35%）为同时性脑转移，120例（65%）为异时性脑转移。不考虑脑转移瘤，68例患者（37%）为I期癌，13例（7%）为II期癌，62例（33%）为IIIA期癌，30例（16%）为IIIB期癌，12例（6%）为IV期癌。同时性和异时性病变患者在年龄、局部区域分期（TN）或组织学特征方面无显著差异。185例患者的总生存率如下：1年生存率为55%；2年生存率为27%；3年生存率为18%；5年生存率为13%；10年生存率为7%（中位数为14个月）。同时性和异时性病变患者的生存率无显著差异。为了评估局部区域分期和原发部位治疗的影响，我们仅分析了那些同时性脑转移的患者。多因素分析表明，局部区域分期对生存率无显著影响（p = 0.97），但原发疾病的完全切除显著延长了生存期（p = 0.002）。因此，对于接受非小细胞肺癌脑转移瘤切除术的患者，局部区域原发病变的完全切除而非分期是生存的主要决定因素。
