脑转移瘤切除术后的体能状态改善和全身治疗进展：一项非小细胞肺癌患者回顾性单中心队列研究。
Performance status improvement and advances in systemic treatment after brain metastases resection: a retrospective single-center cohort study of non-small cell lung cancer patients.
机构信息
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
出版信息
BMC Cancer. 2024 Aug 21;24(1):1030. doi: 10.1186/s12885-024-12798-2.
BACKGROUND
Brain metastasis (BrM) is prevalent among patients with NSCLC, and surgical resection of BrM constitutes a promising treatment strategy for local management and histopathological diagnosis, although it is offered for a select group of patients. Limited information exists concerning the improvement in performance status (PS) following BrM resection or the outcomes stratified by subsequent systemic therapy.
METHODS
We conducted a retrospective single-center cohort study including NSCLC patients with surgically resected BrM and focused on the improvement in PS and subsequent therapy after BrM resection.
RESULTS
71 patients were included, and the median overall survival was 18.3 months (95% confidence interval [95% CI]: 8.7, not reached). Patients with NSCLC who underwent surgical resection of BrM showed significant improvement in PS (18% and 39% showed ECOG PS of 0-1, before and after BrM resection, respectively [p = 0.006]), and patients with PS improvement were younger than those with PS unimprovement (median, 62 years versus 66 years; p = 0.041). Regarding subsequent systemic therapy after BrM resection, 21 patients (30%) received cytotoxic chemotherapy, 14 patients (20%) received tyrosine kinase inhibitors (TKIs), 3 patients (4%) received immune checkpoint inhibitors (ICIs), and 21 patients (30%) received no subsequent therapy. The survival outcomes of patients stratified by subsequent systemic treatments suggested the tendency that those who received TKI or ICI showed better survival outcomes, although a small number of patients hindered statistical comparisons.
CONCLUSIONS
We describe the outcomes of patients with NSCLC who underwent surgical resection of BrM, revealing that younger patients were more likely to anticipate improvement in PS, and patients who received TKI or ICI after BrM resection tended to exhibit a more preferable prognosis.
背景
脑转移瘤（BrM）在非小细胞肺癌（NSCLC）患者中较为常见，手术切除 BrM 是一种有前途的局部管理和组织病理学诊断治疗策略，尽管该方法仅适用于一部分患者。目前关于手术切除 BrM 后患者体能状态（PS）改善的信息有限，也缺乏对接受 BrM 切除术后接受后续系统性治疗患者的结局进行分层的相关信息。
方法
我们进行了一项回顾性单中心队列研究，纳入了接受手术切除 BrM 的 NSCLC 患者，并重点关注 BrM 切除术后 PS 的改善和后续治疗情况。
结果
共纳入 71 例患者，中位总生存期为 18.3 个月（95%置信区间[95%CI]：8.7，未达到）。接受 BrM 切除术的 NSCLC 患者 PS 显著改善（分别有 18%和 39%的患者在 BrM 切除前后 ECOG PS 为 0-1，p=0.006），且 PS 改善的患者比 PS 未改善的患者年轻（中位数分别为 62 岁和 66 岁；p=0.041）。关于 BrM 切除术后的后续系统性治疗，21 例（30%）患者接受细胞毒性化疗，14 例（20%）患者接受酪氨酸激酶抑制剂（TKI）治疗，3 例（4%）患者接受免疫检查点抑制剂（ICI）治疗，21 例（30%）患者未接受后续治疗。对接受 BrM 切除术后接受不同系统性治疗的患者进行分层后，生存结局提示 TKI 或 ICI 治疗的患者可能有更好的生存获益，但由于患者数量较少，统计学比较受限。
结论
我们描述了接受手术切除 BrM 的 NSCLC 患者的结局，结果显示年轻患者更有可能改善 PS，而接受 BrM 切除术后接受 TKI 或 ICI 治疗的患者倾向于表现出更有利的预后。
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