Proescholdt Martin, Jünger Stephanie T, Schödel Petra, Schebesch Karl-Michael, Doenitz Christian, Pukrop Tobias, Höhne Julius, Schmidt Nils-Ole, Kocher Martin, Schulz Holger, Ruge Maximilian, König Kevin, Goldbrunner Roland, Grau Stefan
Department of Neurosurgery, University Hospital Regensburg, Franz Josef Strauß Allee 11, 93053 Regensburg, Germany.
Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, Franz Josef Strauß Allee 11, 93053 Regensburg, Germany.
Brain Sci. 2021 Jan 18;11(1):123. doi: 10.3390/brainsci11010123.
In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups ( = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 . B: 8.12 months; = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival ( = 0.00001). However, elderly patients less frequently received systemic treatment ( = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score ( = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.
在脑转移瘤（BM）患者中，高龄被认为是一个负面预后因素。为探究其潜在原因，我们评估了807例行BM切除术的患者；将315例年龄至少65岁的患者（A组）与492例较年轻患者（B组）进行比较。我们分析了术前和术后卡氏功能状态评分（KPS）、术后治疗结构及治疗后生存情况的影响。BM切除术使两组患者的KPS评分均显著提高（ = 0.0001）。两组患者BM切除术后的中位生存期差异显著（A组：5.81个月，B组：8.12个月； = 0.0015）。在两组中，接受术后全身治疗的患者总生存期显著更长（ = 0.00001）。然而，老年患者接受全身治疗的频率较低（ = 0.0001），且接受此类治疗的老年患者亚组术后KPS评分显著更高（ = 0.0007）。在所有接受全身治疗的患者中，年龄不再是负面预后因素。BM切除术改善了老年患者的功能状态，从而增加了接受全身治疗的可能性，这进而导致更长的总生存期。在这样的治疗结构背景下，仅年龄不再是生存的预后因素。
