Kancharla Pragnan, Ivanov Alexander, Chan Susie, Ashamalla Hani, Huang Raymond Y, Yanagihara Ted K
Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.
Department of Radiation Oncology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.
Neurooncol Adv. 2019 Sep 13;1(1):vdz017. doi: 10.1093/noajnl/vdz017. eCollection 2019 May-Dec.
It is common clinical practice to consider the location of a brain metastasis when making decisions regarding local therapies and, in some scenarios, estimating clinical outcomes, such as local disease control and patient survival. However, the location of a brain metastasis is not included in any validated prognostic nomogram and it is unclear if this is due to a lack of a relationship or a lack of support from published data. We performed a comprehensive review of the literature focusing on studies that have investigated a relationship between brain metastasis location and clinical outcomes, including patient survival. The vast majority of reports anatomically categorized brain metastases as supratentorial or infratentorial whereas some reports also considered other subdivisions of the brain, including different lobes or with particular areas defined as eloquent cortex. Results were variable across studies, with some finding a relationship between metastasis location and survival, but the majority finding either no relationship or a weak correlation that was not significant in the context of multivariable analysis. Here, we highlight the key findings and limitations of many studies, including how neurosurgical resection might influence the relative importance of metastasis location and in what ways future analyses may improve anatomical categorization and resection status.
在做出关于局部治疗的决策以及在某些情况下估计临床结局（如局部疾病控制和患者生存）时，考虑脑转移瘤的位置是常见的临床做法。然而，脑转移瘤的位置并未包含在任何经过验证的预后列线图中，目前尚不清楚这是由于缺乏相关性还是缺乏已发表数据的支持。我们对文献进行了全面综述，重点关注那些研究脑转移瘤位置与临床结局（包括患者生存）之间关系的研究。绝大多数报告在解剖学上将脑转移瘤分为幕上或幕下，而一些报告还考虑了脑的其他细分区域，包括不同脑叶或定义为明确皮层的特定区域。各研究结果不一，一些研究发现转移瘤位置与生存之间存在关系，但大多数研究要么未发现关系，要么发现的相关性较弱，在多变量分析中不显著。在此，我们强调许多研究的关键发现和局限性，包括神经外科手术切除可能如何影响转移瘤位置的相对重要性，以及未来分析可能以何种方式改善解剖学分类和切除状态。
