Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway.
Clin Transl Oncol. 2017 Sep;19(9):1141-1146. doi: 10.1007/s12094-017-1651-0. Epub 2017 Mar 29.
According to the recent TNM 8 classification, patients with metastatic non-small cell lung cancer (NSCLC) and single extrathoracic metastasis should be classified as stage M1b, while those with 2 or more metastases comprise stage M1c. The purpose of this study was to analyze the impact of this classification in patients with brain metastases.
This retrospective study included 172 patients treated with individualized approaches. Actuarial survival was calculated. Uni- and multivariate analyses were performed.
Thirty patients (17%) were staged as M1b. Those with squamous cell cancer were more likely to harbor M1b disease (29%, adenocarcinoma 14%, other histology 17%, p = 0.16). Median survival was 5.4 months (8.0 months in case of M1b disease and 4.5 months in case of M1c disease, p = 0.001). Multivariate analysis confirmed the role of M1b stage. M1b patients managed with upfront surgery or radiosurgery had significantly longer median survival than those who received whole-brain irradiation (21.0 vs. 3.5 months, p = 0.0001) and the potential to survive beyond 5 years.
We found the M1b classification to provide clinically relevant information. The multivariate analysis suggested that patients with M1b disease, better performance status and younger age have better survival.
根据最近的 TNM8 分类，患有转移性非小细胞肺癌（NSCLC）和单一胸外转移的患者应归类为 M1b 期，而有 2 个或更多转移灶的患者属于 M1c 期。本研究的目的是分析这一分类对脑转移患者的影响。
本回顾性研究纳入了 172 例接受个体化治疗的患者。计算了生存率的估计值。进行了单变量和多变量分析。
30 例（17%）患者分期为 M1b。鳞状细胞癌患者更有可能患有 M1b 疾病（29%，腺癌 14%，其他组织学类型 17%，p=0.16）。中位生存时间为 5.4 个月（M1b 疾病为 8.0 个月，M1c 疾病为 4.5 个月，p=0.001）。多变量分析证实了 M1b 分期的作用。与接受全脑放疗的患者相比，接受 upfront 手术或放射外科治疗的 M1b 患者的中位生存时间显著延长（21.0 个月 vs. 3.5 个月，p=0.0001），且有超过 5 年的生存潜力。
我们发现 M1b 分类提供了临床相关信息。多变量分析表明，M1b 疾病患者、更好的体能状态和更年轻的年龄与更好的生存相关。
