Wroński M, Arbit E, Burt M, Galicich J H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Neurosurg. 1995 Oct;83(4):605-16. doi: 10.3171/jns.1995.83.4.0605.
The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; post-operative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.
作者回顾了1976年至1991年间231例行非小细胞肺癌脑转移瘤切除术患者的记录。回顾性收集了有关原发疾病和脑转移瘤特征的数据。首次开颅术后该组患者的中位生存期为11个月；术后死亡率为3%。1年、2年、3年和5年生存率分别为46.3%、24.2%、14.7%和12.5%。112名女性的生存期明显长于119名男性（13.8个月对9.5个月，p<0.02）。单发转移瘤患者（200例）的生存期长于多发转移瘤患者（31例）（11.1个月对8.5个月，p<0.02）。幕上肿瘤患者的生存期长于小脑病变患者。术前卡氏功能状态评分高也表明生存期延长。多因素分析显示，原发性肺肿瘤未完全切除或未切除、男性、幕下位置、存在全身转移以及年龄大于60岁与生存期缩短显著相关。约三分之一的患者死于神经原因，三分之一死于全身疾病，三分之一死于两者的合并症。该系列研究结果证实，即使是单个可切除脑转移瘤患者的总体预后也很差，但积极治疗可延长生命并保留生活质量，偶尔还可实现长期生存。
