Nieder Carsten, Aanes Siv Gyda, Stanisavljevic Luka, Mannsåker Bård, Haukland Ellinor Christin
Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
J Neurooncol. 2025 Jan;171(1):139-154. doi: 10.1007/s11060-024-04840-x. Epub 2024 Oct 1.
The study's purpose was to analyze return to work and other long-term outcomes in younger patients with newly diagnosed brain metastases, treated before they reached legal retirement age, i.e. younger than 65 years.
We included patients who survived greater than 2 years after their first treatment, regardless of approach (systemic therapy, neurosurgical resection, whole-brain or stereotactic radiotherapy). The primary endpoint was the proportion of patients who worked 2 years after their initial treatment for brain metastases. Outcomes beyond the 2-year cut-off were also abstracted from comprehensive electronic health records, throughout the follow-up period.
Of 455 patients who received active therapy for brain metastases, 62 (14%) survived for > 2 years. Twenty-eight were younger than 65 years. The actuarial median survival was 81 months and the 5-year survival rate 53%. For patients alive after 5 years, the 10-year survival rate was 54%. At diagnosis, 25% of patients (7 of 28) were permanently incapacitated for work/retired. Of the remaining 21 patients, 33% did work 2 years later. However, several of these patients went on to receive disability pension afterwards. Eventually, 19% continued working in the longer run. Younger age, absence of extracranial metastases, presence of a single brain metastasis, and Karnofsky performance status 90-100 were common features of patients who worked after 2 years.
Long-term survival was achieved after vastly different therapeutic approaches, regarding both upfront and sequential management. Many patients required three or more lines of brain-directed treatment. Few patients continued working in the longer run.
本研究旨在分析新诊断为脑转移瘤且在法定退休年龄之前（即65岁以下）接受治疗的年轻患者的重返工作岗位情况及其他长期预后。
我们纳入了首次治疗后存活超过2年的患者，无论治疗方法（全身治疗、神经外科手术切除、全脑或立体定向放射治疗）如何。主要终点是脑转移瘤初始治疗后2年仍在工作的患者比例。在整个随访期间，还从综合电子健康记录中提取了超过2年截止时间的预后情况。
在455例接受脑转移瘤积极治疗的患者中，62例（14%）存活超过2年。其中28例年龄小于65岁。精算中位生存期为81个月，5年生存率为53%。对于存活5年以上的患者，10年生存率为54%。诊断时，25%的患者（28例中的7例）永久丧失工作能力/退休。在其余21例患者中，33%在2年后仍在工作。然而，这些患者中有几例后来领取了残疾抚恤金。最终，19%的患者长期继续工作。年龄较轻、无颅外转移、存在单个脑转移瘤以及卡诺夫斯基功能状态为90 - 100是2年后仍在工作的患者的常见特征。
无论采用前期和序贯管理的何种截然不同的治疗方法，均实现了长期生存。许多患者需要三线或更多线的脑定向治疗。长期继续工作的患者很少。
