Armocida Daniele, Zancana Giuseppa, Bianconi Andrea, Cofano Fabio, Pesce Alessandro, Ascenzi Brandon Matteo, Bini Paola, Marchioni Enrico, Garbossa Diego, Frati Alessandro
Experimental Neurosurgery Unit, IRCCS "Neuromed", via Atinense 18, 86077, Pozzilli, IS, Italy.
Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Via cherasco 15, 10126, Turin, TO, Italy.
World Neurosurg X. 2024 May 1;23:100391. doi: 10.1016/j.wnsx.2024.100391. eCollection 2024 Jul.
Brain metastases (BMs) most frequently originate from the primary tumors of the lung and breast. Survival in patients with BM can improve if they are detected early. No studies attempt to consider all potential surgical predictive factors together by including clinical, radiological variables for their recognition.
The study aims to simultaneously analyze all clinical, radiologic, and surgical variables on a cohort of 314 patients with surgically-treated BMs to recognize the main features and differences between the two histotypes.
The two groups consisted of 179 BM patients from lung cancer (Group A) and 135 patients from breast cancer (Group B). Analysis showed that BMs from breast carcinoma are more likely to appear in younger patients, tend to occur in the infratentorial site and are frequently found in patients who have other metastases outside of the brain (46 %, p = 0.05), particularly in bones. On the other hand, BMs from lung cancer often occur simultaneously with primitive diagnosis, are more commonly cystic, and have a larger edema volume. However, no differences were found in the extent of resection, postoperative complications or the presence of decreased postoperative performance status.
The data presented in this study reveal that while the two most prevalent forms of BM exhibit distinctions with respect to clinical onset, age, tumor location, presence of extra-cranial metastases, and lesion morphology from a strictly surgical standpoint, they are indistinguishable with regard to outcome, demonstrating comparable resection rates and a low risk of complications.
脑转移瘤（BMs）最常起源于肺癌和乳腺癌的原发性肿瘤。如果能早期发现，BMs患者的生存率会提高。尚无研究试图通过纳入临床、放射学变量来综合考虑所有潜在的手术预测因素以识别这些因素。
本研究旨在同时分析314例接受手术治疗的BMs患者队列的所有临床、放射学和手术变量，以识别两种组织学类型之间的主要特征和差异。
两组包括179例肺癌脑转移患者（A组）和135例乳腺癌脑转移患者（B组）。分析表明，乳腺癌脑转移更易出现在年轻患者中，倾向于发生在幕下部位，且常见于脑外有其他转移灶的患者（46%，p = 0.05），尤其是骨转移。另一方面，肺癌脑转移常与原发诊断同时出现，更常见为囊性，且水肿体积更大。然而，在切除范围、术后并发症或术后功能状态下降方面未发现差异。
本研究呈现的数据表明，从严格的手术角度来看，虽然两种最常见的BMs形式在临床发病、年龄、肿瘤位置、颅外转移的存在以及病变形态方面存在差异，但在预后方面并无区别，显示出相当的切除率和较低的并发症风险。
