Chaichana Kaisorn L, Gadkaree Shekhar, Rao Karthik, Link Thomas, Rigamonti Daniele, Purtell Michael, Browner Ilene, Weingart Jon, Olivi Alessandro, Gallia Gary, Bettegowda Chetan, Brem Henry, Lim Michael, Quinones-Hinojosa Alfredo
Johns Hopkins University, Baltimore, MD, USA.
Neurol Res. 2013 Dec;35(10):1059-69. doi: 10.1179/1743132813Y.0000000253. Epub 2013 Aug 16.
Patients with a variety of different primary cancers can develop intracranial metastases. Patients who develop intracranial metastases are often grouped into the same study population, and therefore an understanding of outcomes for patients with different primary cancers remain unclear.
Adults who underwent intracranial metastatic tumor surgery from 1997-2011 at a single institution were retrospectively reviewed. Primary pathologies were compared using Fisher's exact and Student's t-test, and Cox regression analysis was used to identify factors associated with survival.
About 708 patients underwent surgery during the reviewed period, where 269 (38%) had non-small cell lung cancer (NSCLC), 106 (15%) breast cancer (BC), 72 (10%) gastrointestinal (GI) cancers, 88 (12%) renal cell cancer (RCC), and 88 (12%) melanoma. The most notable differences were that NSCLC patients were older, BC younger, BC had more primary tumor control, and NSCLC less extracranial spread. BC had longer survival, RCC had longer local progression free survival (PFS), and NSCLC had longer distal PFS. The factors independently associated with survival for NSCLC (female, recursive partitioning analysis (RPA) class, primary tumor control, solitary metastasis, tumor size, adenocarcinoma, radiation, discharge to home), BC (age, no skull base involvement, radiation), GI cancer (age, RPA class, Karnofsky performance scale (KPS), lack of preoperative motor deficit, non-esophageal tumors, non-hemorrhagic tumors, avoidance of new deficits), melanoma (preoperative seizures, solitary metastasis, smaller tumor size, discharge to home, chemotherapy), and RCC (KPS, chemotherapy) were distinctly different.
These differences between patients with different primary cancers support the fact that patients with intracranial disease are not all the same and should be studied by their primary pathology.
患有各种不同原发性癌症的患者可发生颅内转移。发生颅内转移的患者常被归为同一研究人群，因此，对于不同原发性癌症患者的预后情况仍不清楚。
对1997年至2011年在一家机构接受颅内转移性肿瘤手术的成年人进行回顾性研究。使用Fisher精确检验和Student t检验比较原发性病理情况，并采用Cox回归分析确定与生存相关的因素。
在研究期间，约708例患者接受了手术，其中269例（38%）患有非小细胞肺癌（NSCLC），106例（15%）患有乳腺癌（BC），72例（10%）患有胃肠道（GI）癌，88例（12%）患有肾细胞癌（RCC），88例（12%）患有黑色素瘤。最显著的差异在于，NSCLC患者年龄较大，BC患者年龄较小，BC患者的原发肿瘤控制情况更好，而NSCLC患者的颅外转移较少。BC患者的生存期更长，RCC患者的局部无进展生存期（PFS）更长，NSCLC患者的远处PFS更长。与NSCLC生存独立相关的因素（女性、递归分区分析（RPA）分级、原发肿瘤控制、孤立转移、肿瘤大小、腺癌、放疗、出院回家）、BC（年龄、无颅底受累、放疗）、GI癌（年龄、RPA分级、卡诺夫斯基功能状态评分（KPS）、术前无运动功能障碍、非食管肿瘤、非出血性肿瘤、避免出现新的功能障碍）、黑色素瘤（术前癫痫发作、孤立转移、肿瘤较小、出院回家、化疗）和RCC（KPS、化疗）明显不同。
不同原发性癌症患者之间的这些差异支持了这样一个事实，即患有颅内疾病的患者并非都相同，应该根据其原发性病理情况进行研究。
