复发性脑转移瘤患者的治疗。对109例非小细胞肺癌患者的回顾性分析。

The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer.

作者信息

Arbit E, Wroński M, Burt M, Galicich J H

机构信息

Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

出版信息

Cancer. 1995 Sep 1;76(5):765-73. doi: 10.1002/1097-0142(19950901)76:5<765::aid-cncr2820760509>3.0.co;2-e.

DOI:10.1002/1097-0142(19950901)76:5<765::aid-cncr2820760509>3.0.co;2-e

PMID:8625178

Abstract

BACKGROUND

Brain metastases represent a major source of morbidity in patients with cancer.

METHODS

Treatment outcomes were analyzed retrospectively in 214 patients with brain metastases from nonsmall cell lung cancer (NSCLC) who underwent resection at Memorial Hospital (New York, NY) between January, 1976, and December, 1990.

RESULTS

The study group included 109 patients (51%) with symptomatic recurrent brain tumors (median, 5.0 months after complete resection). Recurrence in the brain was at the original site in 62% of patients and at other sites in 38%. The median survival (MS) was 11.3 months in the recurrence group compared with 9.5 months (P < 0.5) in the nonrecurrence group (N = 105). Thirty-two patients had further surgery after recurrence; their median relapse time was 5.2 months. In these patients, survival (MS, 15.0 months) calculated from the time of their first operation, was significantly different (P < 0.001) from that of patients who did not undergo a second procedure (N = 77) (MS, 10.0 months). In the 32 patients who underwent reoperation, MS from the time of the second operation was 10 months, whereas the median interval from the first operation was 5 months (average, 5.7 months). Eight of these 32 patients had a third operation, after a median relapse time of 4 months; their MS was 42 months. There was a significant difference (P < 0.02) between the MS of 39 patients synchronously diagnosed with lung cancer and brain metastasis (MS, 9.0 months) and 70 metachronously diagnosed patients (MS, 14.6 months). Women (N = 55) survived longer than men (N = 54) (14.4 months vs. 9.7 months, P < 0.01). Univariate analysis showed that histology, disease stage, and completeness of resection of the primary tumor also affected survival (P < 0.02, P < 0.014, and P < 0.001, respectively). Although no significant difference was found between survival of patients with recurrence in the supratentorial space and patients with recurrence in the posterior fossa (MS, 11.4 months vs. 11.2 months, P < 0.13), no one from the latter subgroup survived 3 years.

CONCLUSIONS

If technically feasible, further surgery is effective in prolonging the survival of patients with NSCLC who have recurring brain metastases.

摘要

背景

脑转移瘤是癌症患者发病的主要来源。

方法

对1976年1月至1990年12月间在纪念医院（纽约，纽约州）接受手术切除的214例非小细胞肺癌（NSCLC）脑转移患者的治疗结果进行回顾性分析。

结果

研究组包括109例（51%）有症状的复发性脑肿瘤患者（中位时间为完全切除后5.0个月）。62%的患者脑部复发位于原部位，38%位于其他部位。复发组的中位生存期（MS）为11.3个月，而非复发组（N = 105）为9.5个月（P < 0.5）。32例患者复发后接受了进一步手术；他们的中位复发时间为5.2个月。在这些患者中，从首次手术时间算起的生存期（MS，15.0个月）与未接受二次手术的患者（N = 77）（MS，10.0个月）有显著差异（P < 0.001）。在接受再次手术的32例患者中，第二次手术时间算起的MS为10个月，而从首次手术算起的中位间隔时间为5个月（平均5.7个月）。这32例患者中有8例在中位复发时间4个月后接受了第三次手术；他们的MS为42个月。39例同步诊断为肺癌和脑转移的患者的MS（9.0个月）与70例异时诊断的患者（MS，14.6个月）之间存在显著差异（P < 0.02）。女性（N = 55）的生存期长于男性（N = 54）（14.4个月对9.7个月，P < 0.01）。单因素分析表明，组织学、疾病分期和原发肿瘤切除的完整性也影响生存期（分别为P < 0.02、P < 0.014和P < 0.001）。尽管幕上空间复发患者与后颅窝复发患者的生存期无显著差异（MS，11.4个月对11.2个月，P < 0.13），但后一组亚组中无人存活3年。