首次诊断为脑转移瘤后的生存情况及生活质量：一项多中心、前瞻性、观察性研究。
Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study.
作者信息
Yri Olav Erich, Astrup Guro Lindviksmoen, Karlsson Astrid Telhaug, van Helvoirt Rene, Hjermstad Marianne Jensen, Husby Kristin Moksnes, Loge Jon Håvard, Lund Jo-Åsmund, Lundeby Tonje, Paulsen Ørnulf, Skovlund Eva, Taran Marius-Ioan, Winther Rebecca Rootwelt, Aass Nina, Kaasa Stein
机构信息
Department of Oncology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway.
European Palliative Care Research Centre (PRC), Institute for Clinical Medicine, PO Box 1171, Blindern, Oslo, 0318, Norway.
出版信息
Lancet Reg Health Eur. 2024 Dec 19;49:101181. doi: 10.1016/j.lanepe.2024.101181. eCollection 2025 Feb.
BACKGROUND
A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions.
METHODS
This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox' proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups.
FINDINGS
For the total cohort ( = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2-6.7). ECOG 2-4, uncontrolled extracranial metastases, and ≥5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3-4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3-3.5]; ECOG 3-4: 2.1 [1.5-2.7]). Patients surviving <6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving >6 months reported stable scores over time.
INTERPRETATION
Patients with ECOG 2-4, especially those with uncontrolled extracranial metastases and ≥5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival <6 months and specifically advise against WBRT.
FUNDING
The South-Eastern Norway Regional Health Authority; The Norwegian Cancer Society.
背景
脑转移瘤（BM）的抗癌治疗（ACT）中一个主要问题是，预期生存期短的患者接受了对生活质量（QoL）有负面影响的治疗。这种临终时的无效ACT对患者及其家人来说既耗时又负担沉重，还带来不必要的医疗费用。对于医生和患者而言，避免进行ACT都具有挑战性。本研究旨在提供BM诊断后的实际生存数据以及ACT后的患者报告结局（PROs），以确定无效治疗的危险因素并支持BM治疗决策。
方法
这项多中心、前瞻性观察性研究纳入了2017年11月至2021年3月期间连续的首次发生BM的患者。对患者进行随访直至死亡或研究结束（2023年10月1日）。通过Cox比例风险模型分析与生存相关的临床因素。根据东部肿瘤协作组（ECOG）的体能状态、生存情况和治疗组来描述BM治疗后PROs的变化。
结果
对于整个队列（n = 912），BM诊断后的中位总生存期（mOS）为5.9个月（95%置信区间[CI] 5.2 - 6.7）。ECOG 2 - 4、未控制的颅外转移以及≥5个BM与生存期短相关。在接受放疗的患者中，ECOG 2的患者和ECOG 3 - 4的患者生存期相似，全脑放疗（WBRT）组的生存期尤其短（ECOG 2：2.9个月[95% CI 2.3 - 3.5]；ECOG 3 - 4：2.1[1.5 - 2.7]）。BM诊断后存活时间<6个月的患者在ACT后两个月报告的QoL评分更差；存活时间>6个月的患者报告的评分随时间保持稳定。
解读
ECOG 2 - 4的患者，尤其是那些有未控制的颅外转移和≥5个BM的患者，存在无效ACT的风险。BM治疗指南应强烈告诫预期生存期<6个月的患者不要进行ACT，并特别建议不要进行WBRT。
资助
挪威东南部地区卫生局；挪威癌症协会。
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