School of Medical Education, Newcastle University Medical School, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Int J Clin Oncol. 2020 Aug;25(8):1475-1482. doi: 10.1007/s10147-020-01687-w. Epub 2020 May 1.
Management of patients with intracranial metastases from an unknown primary tumor (CUP) varies compared to those with metastases of known primary tumor origin (CKP). The National Institute for Health and Care Excellence (NICE) recognizes the current lack of research to support the management of CUP patients with brain metastases. The primary aim was to compare survival outcomes of CKP and CUP patients undergoing early resection of intracranial metastases to understand the efficacy of surgery for patients with CUP.
A retrospective study was performed, wherein patients were identified using a pathology database. Data was collected from patient notes and trust information services. Surgically managed patients during a 10-year period aged over 18 years, with a histological diagnosis of intracranial metastasis, were included.
298 patients were identified, including 243 (82.0%) CKP patients and 55 (18.0%) CUP patients. Median survival for CKP patients was 9 months (95%CI 7.475-10.525); and 6 months for CUP patients (95%CI 4.263-7.737, p = 0.113). Cox regression analyses suggest absence of other metastases (p = 0.016), age (p = 0.005), and performance status (p = 0.001) were positive prognostic factors for improved survival in cases of CUP. The eventual determination of the primary malignancy did not affect overall survival for CUP patients.
There was no significant difference in overall survival between the two groups. Surgical management of patients with CUP brain metastases is an appropriate treatment option. Current diagnostic pathways specifying a thorough search for the primary tumor pre-operatively may not improve patient outcomes.
与已知原发性肿瘤（CKP）来源转移的患者相比，对颅内转移来源不明的肿瘤（CUP）患者的管理存在差异。国家卫生与保健卓越研究所（NICE）认识到目前缺乏支持脑转移 CUP 患者管理的研究。主要目的是比较 CKP 和 CUP 患者行颅内转移灶早期切除的生存结局，以了解手术对 CUP 患者的疗效。
进行了一项回顾性研究，通过病理数据库识别患者。从患者病历和信托信息服务中收集数据。纳入 10 年内年龄超过 18 岁、有颅内转移组织学诊断、行手术治疗的患者。
共识别出 298 例患者，其中 243 例（82.0%）为 CKP 患者，55 例（18.0%）为 CUP 患者。CKP 患者的中位生存期为 9 个月（95%CI 7.475-10.525）；CUP 患者为 6 个月（95%CI 4.263-7.737，p=0.113）。Cox 回归分析表明，无其他转移（p=0.016）、年龄（p=0.005）和功能状态（p=0.001）是 CUP 患者生存改善的阳性预后因素。最终确定原发性恶性肿瘤并不影响 CUP 患者的总生存。
两组患者的总生存无显著差异。CUP 脑转移患者的手术治疗是一种合适的治疗选择。目前指定在术前彻底寻找原发性肿瘤的诊断途径可能不会改善患者的预后。
