Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway;
Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Anticancer Res. 2021 Jan;41(1):341-345. doi: 10.21873/anticanres.14781.
BACKGROUND/AIM: The aim of this study was to identify patients at high risk of death from neurological cause because these patients may be appropriate candidates for intense brain-directed treatment, in contrast to patients with uncontrollable extracranial disease, inevitably leading to death. In this context, the LabBM score (endpoint: overall survival; five blood test results; often abnormal in patients with widespread disease) may be a relevant tool.
This was a retrospective single-institution analysis of 101 patients, managed with upfront brain irradiation. Associations between neurological death and different baseline and treatment parameters were assessed.
A LabBM score of 0 (five normal blood test results) was present in 32% of patients. Neurological death was recorded in 27%. Seven parameters were associated with neurological death, including the LabBM score (univariate analyses). Three out of the seven were significantly associated with neurological death in the multi-nominal logistic regression analysis. The most important parameter was primary tumor type (colorectal or melanoma), with a hazard ratio of 14.3. Patients without liver metastases were also more likely to die from neurological causes. Finally, patients who did not receive additional systemic therapy were more likely to die from central nervous system progression. The median survival time was 3.9 months (entire cohort). When censoring patients who died from extracranial progression, the median time to neurological death was 17.4 months.
The LabBM score was not suitable for prediction of neurological death, in contrast to three other parameters. Interestingly, additional systemic therapy reduced the risk of neurological death, possibly because several new agents have known antitumor activity in the brain.
背景/目的：本研究的目的是确定因神经系统原因死亡风险高的患者，因为与不可控制的颅外疾病患者相比，这些患者可能是强化脑部治疗的合适人选，而不可控制的颅外疾病患者必然导致死亡。在这种情况下，LabBM 评分（终点：总生存率；五项血液检测结果；广泛疾病患者中常异常）可能是一个相关工具。
这是一项回顾性的单机构分析，共纳入 101 例接受初始脑部放疗的患者。评估了不同基线和治疗参数与神经系统死亡之间的关联。
32%的患者存在 LabBM 评分 0 分（五项血液检测结果正常）。记录到 27%的患者发生神经系统死亡。有 7 个参数与神经系统死亡相关，包括 LabBM 评分（单因素分析）。在多变量逻辑回归分析中，有 3 个参数与神经系统死亡显著相关。最重要的参数是原发肿瘤类型（结直肠癌或黑色素瘤），风险比为 14.3。无肝转移的患者也更有可能因神经系统原因死亡。最后，未接受额外全身治疗的患者更有可能因中枢神经系统进展而死亡。整个队列的中位生存时间为 3.9 个月。当排除因颅外进展而死亡的患者时，神经系统死亡的中位时间为 17.4 个月。
与其他三个参数相比，LabBM 评分不适合预测神经系统死亡。有趣的是，额外的全身治疗降低了神经系统死亡的风险，这可能是因为几种新的药物在大脑中有已知的抗肿瘤活性。
