Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
Strahlenther Onkol. 2013 Dec;189(12):996-1000. doi: 10.1007/s00066-013-0442-y. Epub 2013 Oct 10.
This study was performed to evaluate the prognostic role for survival of the number and the type of involved extracranial organs in patients with brain metastasis.
The data of 1146 patients who received whole-brain radiotherapy (WBRT) alone for brain metastasis have been retrospectively analyzed. In addition to the number of involved extra cranial organs, seven potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), primary tumor type, number of brain metastases, and the interval from cancer diagnosis to WBRT. Additionally, subgroup analyses were performed for patients with involvement of one (lung vs. bone vs. liver vs. other metastasis) and two (lung + lymph nodes vs. lung + bone vs. lung + liver vs. liver + bone vs. other combinations) extracranial organs.
The 6-month survival rates for the involvement of 0, 1, 2, 3, and ≥4 extracranial organs were 51, 30, 16, 13, and 10%, respectively (p<0.001). On multivariate analysis, the number of involved extracranial organs maintained significance (risk ratio 1.26; 95% confidence interval 1.18-1.34; p<0.001). According to the multivariate analysis, age (p<0.001), gender (p=0.002), and KPS (p<0.001) were also independent prognostic factors for survival. In the subgroup analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the extracranial organ involved.
The number of involved extracranial organs proved to be an independent prognostic factor in patients with brain metastasis, regardless of the organs involved. The number of involved extracranial organs should be considered in future trials designed for patients with brain metastasis.
本研究旨在评估脑转移患者颅外受累器官数量和类型对生存的预后作用。
回顾性分析了 1146 例接受单纯全脑放疗（WBRT）治疗脑转移的患者数据。除了颅外受累器官的数量外，还研究了 7 个潜在的预后因素，包括 WBRT 方案、年龄、性别、卡氏功能状态评分（KPS）、原发肿瘤类型、脑转移瘤数量以及从癌症诊断到 WBRT 的时间间隔。此外，还对累及 1 个（肺转移 vs. 骨转移 vs. 肝转移 vs. 其他转移）和 2 个（肺+淋巴结转移 vs. 肺+骨转移 vs. 肺+肝转移 vs. 肝+骨转移 vs. 其他组合）颅外器官的患者进行了亚组分析。
0、1、2、3 和≥4 个颅外器官受累的 6 个月生存率分别为 51%、30%、16%、13%和 10%（p<0.001）。多因素分析显示，颅外受累器官数量具有显著意义（风险比 1.26；95%置信区间 1.18-1.34；p<0.001）。根据多因素分析，年龄（p<0.001）、性别（p=0.002）和 KPS（p<0.001）也是生存的独立预后因素。在累及 1 个和 2 个颅外器官的患者亚组分析中，根据受累的颅外器官，生存情况无显著差异。
颅外受累器官数量是脑转移患者的独立预后因素，与受累器官无关。在未来脑转移患者的临床试验中，应考虑受累颅外器官的数量。
