CHRU de Tours, Department of Neurosurgery, Tours, France.
Université François-Rabelais de Tours, Inserm, iBrain, UMR U1253, Tours, France.
Neurosurgery. 2019 Jul 1;85(1):117-125. doi: 10.1093/neuros/nyy222.
Twenty percent of all brain metastases (BM) occur in the posterior fossa (PF). Radiotherapy sometimes associated with surgical resection remains the therapeutic option, while Karnovsky performance status and graded prognostic assessment (GPA) are the best preoperative survival prognostic factors.
To explore the prognostic role of peritumoral brain edema in the PF, which has never been explored though its role in supratentorial BM has been debated.
A total of 120 patients diagnosed with PF metastasis who underwent surgical resection were included retrospectively in this analysis. Clinical data were retrieved from electronic patient medical files. The tumor volumes and their associated edema were calculated via manual delineation; subsequently the edema/tumor volume ratio was determined.
In multivariate analysis with Cox multivariate proportional hazard model, the edema to tumor volumes ratio (hazard ratio [HR]: 1.727, 95% confidence interval [CI] 1.427-2.083; P < .0001) was identified as a new strong independent prognosis factor on overall survival (OS) whereas edema volume alone was not (P = .469). Moreover, BM complete resection (HR: 0.447, 95% CI 0.277-0.719; P < .001), low (0-1) World Health Organization status at diagnosis (HR: 2.109, 95% CI 1.481-3.015; P < .0001), high GPA class at diagnosis (HR: 1.77, 95% CI 0.9-2.9; P < .04), and postoperative brain irradiation (HR: 2.019, 95% CI 1.213-3.361; P < .007] were all confirmed as independent predictive factors for survival.
The edema/tumor ratio appears to greatly influence OS in patients suffering from PF metastases unlike the extent of edema alone. This easily determined as well as strong prognostic factor could be used as an interesting tool in clinical practice to help the management of these patients.
20%的脑转移瘤（BM）发生在后颅窝（PF）。放射治疗有时联合手术切除仍然是治疗选择，而 Karnovsky 表现状态和分级预后评估（GPA）是术前生存的最佳预后因素。
探讨 PF 中瘤周水肿的预后作用，尽管其在幕上 BM 中的作用存在争议，但尚未对此进行探讨。
本回顾性分析共纳入 120 例接受手术切除的 PF 转移瘤患者。临床数据从电子病历中提取。通过手动勾画计算肿瘤体积及其相关水肿体积，随后确定水肿/肿瘤体积比。
在 Cox 多变量比例风险模型的多变量分析中，水肿与肿瘤体积比（危险比[HR]：1.727，95%置信区间[CI]：1.427-2.083；P<.0001）被确定为总体生存（OS）的新的独立预后因素，而单独的水肿体积不是（P=.469）。此外，BM 完全切除（HR：0.447，95%CI：0.277-0.719；P<.001）、诊断时低（0-1）世界卫生组织（WHO）状态（HR：2.109，95%CI：1.481-3.015；P<.0001）、诊断时高 GPA 分级（HR：1.77，95%CI：0.9-2.9；P<.04）和术后脑照射（HR：2.019，95%CI：1.213-3.361；P<.007）均被证实为生存的独立预测因素。
与单纯水肿的程度相比，PF 转移瘤患者的水肿/肿瘤比值似乎对 OS 有很大影响。这种易于确定且具有较强预后作用的因素可以作为一种有用的临床工具，帮助管理这些患者。
