Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurgery. 2011 Mar;68(3):705-13; discussion 713. doi: 10.1227/NEU.0b013e31820773b2.
Central nervous system (CNS) metastases are a common occurrence in patients with breast cancer and are identified in up to 30% of patients at autopsy.
To determine population-based estimates of survival times after surgical intervention for Medicare patients with metastatic breast cancer to the brain and spinal column.
Female breast cancer patients with metastases to the brain and spinal column and undergoing neurosurgical treatment were identified through the Surveillance, Epidemiology, and End Results-Medicare database. Estimates of survival were calculated with Kaplan-Meier estimation and a Cox proportional hazards model.
There were 643 patients who underwent neurosurgical treatment of metastatic disease from 1986 to 2005. Of these patients, 264 underwent cranial surgery and 379 underwent spinal surgery. There were 40 deaths during the postoperative hospital admission for an inpatient postoperative death rate of 6.2%. Inpatient death has declined by approximately 50% for surgeries performed in the most recent decade; however, the 30-day mortality rate of 9.0% has remained constant. The median postoperative survival after cranial surgery was 7.8 months (95% confidence interval, 6.2-9.2), after laminectomy was 9.4 months (95% confidence interval, 6.3-15.7), and after spinal fusion was 15.7 months (95% confidence interval, 11.9-18.5). Survival after spinal fusion has increased by approximately 50% in the recent decade. Patients with increased survival after cranial surgery were younger, had fewer comorbidities, and had longer periods from breast cancer diagnosis to surgery. Patients with increased survival after spinal neurosurgery had lower-grade lesions and longer time periods from breast cancer diagnosis to surgical treatment.
After surgically treated metastases, one-third of cranial patients and one-half of spinal patients are alive at 1 year. The overall postoperative survival has increased over time only for spinal fusion procedures.
中枢神经系统（CNS）转移是乳腺癌患者的常见现象，尸检中多达 30%的患者被发现患有此类转移。
确定医疗保险患者脑和脊柱转移性乳腺癌手术后的生存时间的基于人群的估计值。
通过监测、流行病学和最终结果-医疗保险数据库确定脑和脊柱转移并接受神经外科治疗的女性乳腺癌患者。使用 Kaplan-Meier 估计和 Cox 比例风险模型计算生存估计值。
1986 年至 2005 年期间，有 643 名患者接受了转移性疾病的神经外科治疗。这些患者中有 264 名接受了颅部手术，379 名接受了脊柱手术。术后住院期间有 40 例死亡，住院期间术后死亡率为 6.2%。在最近十年进行的手术中，住院死亡人数下降了约 50%；然而，30 天死亡率 9.0%保持不变。颅部手术后的中位术后生存时间为 7.8 个月（95%置信区间，6.2-9.2），椎板切除术为 9.4 个月（95%置信区间，6.3-15.7），脊柱融合术为 15.7 个月（95%置信区间，11.9-18.5）。在最近十年中，脊柱融合术后的生存时间增加了约 50%。颅部手术后生存时间延长的患者年龄较小，合并症较少，从乳腺癌诊断到手术的时间间隔较长。脊柱神经外科手术后生存时间延长的患者病变程度较低，从乳腺癌诊断到手术治疗的时间间隔较长。
在经过手术治疗的转移瘤患者中，三分之一的颅部患者和一半的脊柱患者在 1 年内存活。只有脊柱融合术的整体术后生存率随时间推移而增加。
