Shibahara Ichiyo, Kanamori Masayuki, Watanabe Takashi, Utsunomiya Akihiro, Suzuki Hiroyoshi, Saito Ryuta, Sonoda Yukihiko, Jokura Hidefumi, Uenohara Hiroshi, Tominaga Teiji
Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
World Neurosurg. 2018 May;113:e1-e9. doi: 10.1016/j.wneu.2017.10.145. Epub 2018 Mar 5.
The purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases.
Brain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group.
Of 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035).
The timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.
本研究旨在阐明早期、同时性和异时性脑转移瘤的临床特征、预后以及肿瘤切除的作用。
在早期组中，脑转移瘤在原发性癌症检测之前被发现；在同时性组中，在原发性癌症检测后2个月内被发现；在异时性组中，在原发性癌症检测2个月或更久之后被发现。
在471例脑转移瘤患者中，93例（20%）纳入早期组，76例（16%）纳入同时性组，302例（64%）纳入异时性组。与其他两组相比，早期组往往有症状，卡氏功能状态评分低，有单个大肿瘤，颅外转移不常见，肿瘤切除频繁。在单因素和多因素分析中，三组从脑转移瘤检测开始的总生存期无差异。在471例病例中，97例（21%）接受了手术。在这个手术队列中，早期组手术后的总生存期明显短于异时性组（P = 0.039）。在对年龄、性别、肿瘤大小、原发性癌症和分级预后评估评分进行调整后，异时性转移的风险比为0.52（置信区间，0.29 - 0.95；P = 0.035）。
脑转移瘤诊断的时间是一个不可改变的因素，但会影响患者的人口统计学特征和治疗策略。特别是，早期组是脑转移瘤的一个独特子集，在临床决策过程中需要特别考虑。
