Sørensen J B, Hansen H H, Hansen M, Dombernowsky P
Department of Oncology ONB, Finsen Institute, Copenhagen, Denmark.
J Clin Oncol. 1988 Sep;6(9):1474-80. doi: 10.1200/JCO.1988.6.9.1474.
A consecutive group of 259 patients with inoperable adenocarcinoma of the lung (ACL) were observed to define risk groups for and frequency of brain metastases together with prognosis. All patients received chemotherapy in a three-armed randomized trial. Brain metastases were diagnosed in 25 patients before protocol entry and in 37 during treatment. Brain autopsy was performed in 87 patients and was positive in 38 (44%). Eleven of these (29%) were not diagnosed clinically. Patients younger than 60 years had a somewhat higher overall frequency of brain metastases than older patients. Patients with initial performance status above 60% and patients responding to chemotherapy had higher risk for developing brain metastasis during treatment than other patients, probably because of the increasing cumulated risk for this complication with prolonged survival. Median survival after onset of brain metastases was 73 days and survival was significantly shorter for these patients than for patients without this complication at days 0, 90, 180, and 365 after protocol entry. Thus, brain metastases is a frequent complication in ACL and the frequency increases with prolonged survival. Survival after development of brain metastases is short and it is questionable whether the inclusion of this subgroup of ACL patients into experimental cytostatic treatments is justified.
对连续的259例无法手术的肺腺癌（ACL）患者进行观察，以确定脑转移的风险组、发生率及预后情况。所有患者均参加了一项三臂随机试验并接受化疗。25例患者在方案入组前被诊断出脑转移，37例在治疗期间被诊断出脑转移。87例患者进行了脑尸检，其中38例（44%）呈阳性。其中11例（29%）临床未诊断出。60岁以下患者脑转移的总体发生率略高于老年患者。初始体能状态高于60%的患者以及对化疗有反应的患者在治疗期间发生脑转移的风险高于其他患者，这可能是由于随着生存时间延长，该并发症的累积风险增加。脑转移发生后的中位生存期为73天，在方案入组后的第0、90、180和365天，这些患者的生存期明显短于无此并发症的患者。因此，脑转移是ACL中常见的并发症，其发生率随生存时间延长而增加。脑转移发生后的生存期较短，将这一亚组的ACL患者纳入实验性细胞毒性治疗是否合理值得怀疑。
