Department of Neurosurgery/Neuro-oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Neurosurgery, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, China.
Ann Surg Oncol. 2022 Jun;29(6):3684-3693. doi: 10.1245/s10434-022-11365-y. Epub 2022 Feb 18.
Brain metastases (BMs) are the most serious complication of lung cancer, affecting the prognosis of lung cancer patients, and pose distinct clinical challenges. This study was designed to explore the prognostic factors related to lung cancer BM and the value of surgical resection in BMs from lung cancer.
A retrospective analysis was performed on 714 patients with lung cancer BMs screened between January 2010 and January 2018 at the Sun Yat-sen University Cancer Center. A 1:1 propensity score matching analysis was performed to reduce the potential bias between the surgery and the nonsurgery group. In both the raw and the propensity-score matched dataset, univariate and multivariate Cox proportional hazards regression analyses were used to evaluate risk factors for survival.
After matching, 258 patients (129 surgery, 129 no surgery) were analyzed. Multivariate analyses after propensity score matching demonstrated that surgical resection was an independent protective factor for overall survival (OS), and older age, lower Karnofsky Performance Scale (KPS) score, and extracranial metastases were independent risk factors for worse OS. Patients without extracranial metastases, without synchronous BM and with a single BM had a better prognosis.
The findings showed that surgical resection, age, KPS score, and extracranial metastases are independent prognostic factors for predicting the OS of patients with lung cancer BMs, and surgical resection for brain metastatic lesions could significantly improve the OS. However, only certain groups of patients with BMs can benefit from intracranial lesion resection, such as no extracranial metastases and metachronous metastases.
脑转移（BMs）是肺癌最严重的并发症，影响肺癌患者的预后，并带来明显的临床挑战。本研究旨在探讨与肺癌 BM 相关的预后因素，以及肺癌 BM 手术切除的价值。
对 2010 年 1 月至 2018 年 1 月中山大学肿瘤防治中心筛选的 714 例肺癌脑转移患者进行回顾性分析。采用 1:1 倾向评分匹配分析以减少手术组和非手术组之间的潜在偏倚。在原始和倾向评分匹配数据集均进行单因素和多因素 Cox 比例风险回归分析，以评估生存的风险因素。
匹配后，分析了 258 例患者（手术组 129 例，非手术组 129 例）。倾向评分匹配后的多因素分析表明，手术切除是总生存期（OS）的独立保护因素，而年龄较大、卡氏功能状态评分（KPS）较低和颅外转移是 OS 较差的独立危险因素。无颅外转移、无同步 BM 和单发 BM 的患者预后较好。
研究结果表明，手术切除、年龄、KPS 评分和颅外转移是预测肺癌脑转移患者 OS 的独立预后因素，脑转移灶的手术切除可显著改善 OS。然而，只有某些脑转移患者群体（如无颅外转移和异时性转移）可从颅内病灶切除中获益。
