初诊脑转移瘤患者的诊断特异性预后因素、指标和治疗结局：多机构分析 4259 例患者。

Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients.

机构信息

Gamma Knife Center, University of Minnesota, Minneapolis, MN 55387, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):655-61. doi: 10.1016/j.ijrobp.2009.08.025. Epub 2009 Nov 26.

DOI:10.1016/j.ijrobp.2009.08.025

PMID:19942357

Abstract

PURPOSE

Controversy endures regarding the optimal treatment of patients with brain metastases (BMs). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of the present study was to identify significant diagnosis-specific prognostic factors and indexes (Diagnosis-Specific Graded Prognostic Assessment [DS-GPA]).

METHODS AND MATERIALS

A retrospective database of 5,067 patients treated for BMs between 1985 and 2007 was generated from 11 institutions. After exclusion of the patients with recurrent BMs or incomplete data, 4,259 patients with newly diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of the prognostic factors and outcomes by primary site and treatment were performed. The significant prognostic factors were determined and used to define the DS-GPA prognostic indexes. The DS-GPA scores were calculated and correlated with the outcomes, stratified by diagnosis and treatment.

RESULTS

The significant prognostic factors varied by diagnosis. For non-small-cell lung cancer and small-cell lung cancer, the significant prognostic factors were Karnofsky performance status, age, presence of extracranial metastases, and number of BMs, confirming the original GPA for these diagnoses. For melanoma and renal cell cancer, the significant prognostic factors were Karnofsky performance status and the number of BMs. For breast and gastrointestinal cancer, the only significant prognostic factor was the Karnofsky performance status. Two new DS-GPA indexes were thus designed for breast/gastrointestinal cancer and melanoma/renal cell carcinoma. The median survival by GPA score, diagnosis, and treatment were determined.

CONCLUSION

The prognostic factors for BM patients varied by diagnosis. The original GPA was confirmed for non-small-cell lung cancer and small-cell lung cancer. New DS-GPA indexes were determined for other histologic types and correlated with the outcome, and statistical separation between the groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making.

摘要

目的

关于脑转移瘤（BMs）患者的最佳治疗方法仍存在争议。尽管进行了许多随机试验，但争议仍在继续，这也许是因为 BM 患者是一个异质群体。本研究的目的是确定有意义的诊断特异性预后因素和指标（诊断特异性分级预后评估[DS-GPA]）。

方法和材料

从 11 个机构生成了一个包含 1985 年至 2007 年间治疗的 5067 例 BMs 患者的回顾性数据库。排除复发性 BMs 或数据不完整的患者后，4259 例新诊断的 BMs 患者符合分析条件。对原发部位和治疗的预后因素和结果进行了单因素和多因素分析。确定了显著的预后因素，并用于定义 DS-GPA 预后指标。计算了 DS-GPA 评分，并根据诊断和治疗进行分层，与结果相关联。

结果

显著的预后因素因诊断而异。对于非小细胞肺癌和小细胞肺癌，显著的预后因素是 Karnofsky 表现状态、年龄、是否存在颅外转移以及 BM 的数量，这证实了这两种诊断的原始 GPA。对于黑色素瘤和肾细胞癌，显著的预后因素是 Karnofsky 表现状态和 BM 的数量。对于乳腺癌和胃肠道癌，唯一显著的预后因素是 Karnofsky 表现状态。因此，为乳腺癌/胃肠道癌和黑色素瘤/肾细胞癌设计了两个新的 DS-GPA 指标。通过 GPA 评分、诊断和治疗确定了中位生存时间。