Cagino Kristen, Kahn Ryan, Pannullo Susan, Ashamalla Hani, Chan Susie, Balogun Onyinye, Thomas Charlene, Christos Paul J, Holcomb Kevin, Frey Melissa K, Chapman-Davis Eloise
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA.
Department of Neurological Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA.
Gynecol Oncol Rep. 2020 Oct 31;34:100664. doi: 10.1016/j.gore.2020.100664. eCollection 2020 Nov.
Brain metastasis secondary to gynecologic malignancy is rare and has no definitive management guidelines. In this descriptive study, we aimed to identify prognostic factors and treatments that may be associated with longer overall survival.
Patients with brain metastases from gynecologic malignancies were identified between 2004 and 2019 at two institutions. Descriptive statistics were performed using N (%) and median (interquartile range). Univariate cox proportional hazards regression was performed to evaluate the effect of different factors on overall survival.
32 patients presented with brain metastasis from gynecologic primaries (ovarian/fallopian tube/primary peritoneal n = 14, uterine n = 11, cervical n = 7). Median age of initial cancer diagnosis was 61 (34-79). At initial cancer diagnosis 83% of patients were Stage III/IV and underwent surgery (66%), chemotherapy (100%), and/or pelvic radiation (33%). Median time from initial cancer diagnosis to brain metastasis was 18 months. Treatment of brain metastasis with surgery and radiation compared to stereotactic radiosurgery or whole brain radiation therapy alone revealed a trend toward longer overall survival (p = 0.07). Time from initial cancer diagnosis to brain metastasis was associated with longer overall survival with each one-month increase from initial cancer diagnosis associated with a 7% reduction in risk of death (HR 0.93, 95% CI = 0.89-0.97, p = 0.01). Initial cancer treatment, stage, histology, and number of brain lesions did not affect overall survival.
Patients with brain metastasis secondary to gynecologic malignancies with the longest overall survival had the greatest lag time between initial cancer diagnosis and brain metastasis. Brain metastasis treated with surgery and radiation was associated with longer overall survival.
妇科恶性肿瘤继发脑转移罕见，且尚无明确的治疗指南。在这项描述性研究中，我们旨在确定可能与更长总生存期相关的预后因素和治疗方法。
2004年至2019年间在两家机构确定了患有妇科恶性肿瘤脑转移的患者。使用N（%）和中位数（四分位间距）进行描述性统计。进行单变量cox比例风险回归以评估不同因素对总生存期的影响。
32例患者出现妇科原发性脑转移（卵巢/输卵管/原发性腹膜癌n = 14，子宫癌n = 11，宫颈癌n = 7）。初次癌症诊断时的中位年龄为61岁（34 - 79岁）。初次癌症诊断时，83%的患者为III/IV期，接受了手术（66%）、化疗（100%）和/或盆腔放疗（33%）。从初次癌症诊断到脑转移的中位时间为18个月。与单独使用立体定向放射外科或全脑放射治疗相比，手术和放疗治疗脑转移显示出总生存期更长的趋势（p = 0.07）。从初次癌症诊断到脑转移的时间与更长的总生存期相关，初次癌症诊断后每增加一个月，死亡风险降低7%（风险比0.93，95%置信区间 = 0.89 - 0.97，p = 0.01）。初次癌症治疗、分期、组织学和脑转移灶数量不影响总生存期。
妇科恶性肿瘤继发脑转移且总生存期最长的患者，初次癌症诊断与脑转移之间的间隔时间最长。手术和放疗治疗脑转移与更长的总生存期相关。
