Chaichana Kaisorn Lee, Rao Karthik, Gadkaree Shekhar, Dangelmajer Sean, Bettegowda Chetan, Rigamonti Daniele, Weingart Jon, Olivi Alessandro, Gallia Gary L, Brem Henry, Lim Michael, Quinones-Hinojosa Alfredo
Neurol Res. 2014 Jan;36(1):13-25. doi: 10.1179/1743132813Y.0000000260. Epub 2013 Oct 23.
Patients with cerebellar and non-cerebellar metastases are often included in the same study population, even though posterior fossa lesions typically have different presenting symptoms, clinical outcomes, and complications. This is because the outcomes for patients with cerebellar metastases are unclear.
Adult patients who underwent surgery for an intracranial metastasis (single or multiple) between 2007 and 2011 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify an association between cerebellar location with survival and recurrence.
Of the 708 patients who underwent intracranial metastatic surgery, 140 (19.8%) had surgery for cerebellar metastasis. A cerebellar location was associated with poorer survival [RR (95% CI); 1.231 (1.016-1.523), P = 0.04] and increased spinal recurrence [RR (95% CI); 2.895 (1.491-5.409), P = 0.002], but not local (P = 0.61) or distal recurrence (P = 0.88). The factors independently associated with prolonged survival for patients with cerebellar metastases were: decreasing number of intracranial metastases (P = 0.0002), decreasing tumor size (P = 0.002), and radiation (P = 0.0006). The factors associated with prolonged local progression free survival were: decreasing tumor size (P = 0.0009), non small cell lung cancer (NSCLC) (P = 0.006), non-bladder cancer (P = 0.0005), and post-operative radiation therapy (P = 0.02). The factors independently associated with prolonged distal progression free survival were: age > 40 years (P = 0.02), surgical resection (P = 0.01), and whole brain radiation (WBRT) therapy (P = 0.02).
Patients with cerebellar metastases have more distinct clinical presentations and outcomes than patients with non-cerebellar lesions. The findings of this study may help risk stratify and guide treatment regimens aimed at maximizing outcomes for patients with cerebellar metastases.
小脑转移瘤和非小脑转移瘤患者常被纳入同一研究人群，尽管后颅窝病变通常具有不同的临床表现、临床结局和并发症。这是因为小脑转移瘤患者的结局尚不清楚。
对2007年至2011年间接受颅内转移瘤（单发或多发）手术的成年患者进行回顾性分析。采用逐步多因素比例风险回归分析确定小脑位置与生存及复发之间的关联。
在708例行颅内转移瘤手术的患者中，140例（19.8%）接受了小脑转移瘤手术。小脑位置与较差的生存率相关[风险比（95%置信区间）；1.231（1.016 - 1.523），P = 0.04]，且脊柱复发增加[风险比（95%置信区间）；2.895（1.491 - 5.409），P = 0.002]，但与局部复发（P = 0.61）或远处复发无关（P = 0.88）。与小脑转移瘤患者生存期延长独立相关的因素为：颅内转移瘤数量减少（P = 0.0002）、肿瘤大小减小（P = 0.002）和放疗（P = 0.0006）。与局部无进展生存期延长相关的因素为：肿瘤大小减小（P = 0.0009）、非小细胞肺癌（NSCLC）（P = 0.006）、非膀胱癌（P = 0.0005）和术后放疗（P = 0.02）。与远处无进展生存期延长独立相关的因素为：年龄>40岁（P = 0.02）、手术切除（P = 0.01）和全脑放疗（WBRT）治疗（P = 0.02）。
小脑转移瘤患者比非小脑病变患者具有更独特的临床表现和结局。本研究结果可能有助于进行风险分层，并指导旨在使小脑转移瘤患者结局最大化的治疗方案。
