近期提出的一种用于预测行多次立体定向放射手术的脑转移瘤患者预后的新分级指数（脑转移瘤速率）的有效性。

Validity of a Recently Proposed Prognostic Grading Index, Brain Metastasis Velocity, for Patients With Brain Metastasis Undergoing Multiple Radiosurgical Procedures.

机构信息

Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.

Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):631-637. doi: 10.1016/j.ijrobp.2018.10.036. Epub 2018 Nov 3.

DOI:10.1016/j.ijrobp.2018.10.036

PMID:30395905

Abstract

PURPOSE

This study of our patients with brain metastasis who underwent multiple stereotactic radiosurgery (SRS) procedures aimed to validate whether the recently proposed prognostic grading system, brain metastasis velocity (BMV), is generally applicable. The BMV scores the cumulative number of new brain metastases that developed after the first SRS divided by time (years) since the initial SRS. Patients were categorized into 3 classes by their BMV scores (ie, ≤3, 4-13, and ≥14).

METHODS AND MATERIALS

This retrospective cohort study was approved by the Tokyo Women's Medical University Institutional Review Board (number 1981). We used our prospectively accumulated database, which included 833 patients who underwent a second SRS procedure for newly detected lesions, using a gamma knife, for brain metastases. Patients who had whole-brain radiation therapy were excluded. The procedures took place during the 19-year period between July 1998 and June 2017. Furthermore, among the 833 patients, 250 underwent a third SRS procedure, and 88 had a fourth SRS procedure.

RESULTS

The median survival times (MSTs) after the second SRS were 12.9 months (95% confidence interval [CI], 10.2-17.1) for the BMV group with a score of ≤3; 7.5 months (CI, 6.5-9.0) for the group scoring 4 to 13, and 5.1 months (CI, 4.0-5.6) for the group scoring ≥14 (P = .0001). The corresponding MSTs after the third SRS were 13.2 months (95% CI, 9.1-21.6), 8.0 months (CI, 6.2-11.2), and 5.7 months (CI, 4.8-7.8; P = .0001). Respective MSTs after the fourth SRS were 13.2 months (95% CI, 9.1-21.6), 8.0 months (CI, 6.2-11.2), and 5.7 months (CI, 4.8-7.8; P < .0001). The mean BMV score of patients with small cell lung cancer, 24.8, was significantly higher than that of patients with non-small cell lung cancer, 17.7 (P = .032).

CONCLUSIONS

Our present results support the validity of BMV for predicting survival not only after the second SRS but also after the third and fourth SRS.

摘要

目的

本研究对接受多次立体定向放射外科（SRS）治疗的脑转移患者进行了研究，旨在验证最近提出的预后分级系统——脑转移速度（BMV）是否具有普遍适用性。BMV 评分是指首次 SRS 后新发生的脑转移数量与自首次 SRS 以来的时间（年）的比值。患者的 BMV 评分分为 3 类（即≤3、4-13 和≥14）。

方法和材料

本回顾性队列研究获得了东京女子医科大学机构审查委员会的批准（编号 1981）。我们使用了前瞻性累积数据库，该数据库包含了 833 名在 19 年间（1998 年 7 月至 2017 年 6 月）接受伽玛刀治疗新发现病变的脑转移患者的资料。排除了接受全脑放疗的患者。在这 833 名患者中，有 250 名患者接受了第三次 SRS 治疗，88 名患者接受了第四次 SRS 治疗。

结果

第二次 SRS 后的中位生存时间（MST）为 BMV 评分≤3 的患者为 12.9 个月（95%置信区间[CI]：10.2-17.1）；评分 4-13 的患者为 7.5 个月（CI：6.5-9.0）；评分≥14 的患者为 5.1 个月（CI：4.0-5.6）（P=.0001）。第三次 SRS 后的相应 MST 为 13.2 个月（95% CI：9.1-21.6）、8.0 个月（CI：6.2-11.2）和 5.7 个月（CI：4.8-7.8；P=.0001）。第四次 SRS 后的相应 MST 分别为 13.2 个月（95% CI：9.1-21.6）、8.0 个月（CI：6.2-11.2）和 5.7 个月（CI：4.8-7.8；P<.0001）。小细胞肺癌患者的平均 BMV 评分 24.8 明显高于非小细胞肺癌患者的 17.7（P=.032）。