Nussbaum E S, Djalilian H R, Cho K H, Hall W A
Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
Cancer. 1996 Oct 15;78(8):1781-8.
With the advent of new therapies for metastatic carcinoma to the brain, patterns of intracranial disease and factors influencing survival become important considerations when examining potential treatment options.
The records of 729 patients with metastases to the brain treated during the period between 1973 to 1993 were reviewed.
Primary tumor histologic type in order of descending frequency included nonsmall cell lung carcinoma (NSCLC), breast carcinoma, small cell lung carcinoma (SCLC), malignant melanoma, renal cell carcinoma, gastrointestinal carcinoma, uterine/vulvar carcinoma, and unknown primary carcinoma. There were 384 patients (53%) with a single brain metastasis, which was encountered most commonly in patients with prostate carcinoma and least often in patients with SCLC. Multiple metastases were present in 345 patients (47%). The median duration from diagnosis to presentation with a brain metastasis was 12 months, ranging from 3 months for patients with NSCLC to 53 months for patients with breast carcinoma. The median duration from presentation with brain metastases to death was 4 months, ranging from 3 months for patients with SCLC to 13 months for patients with prostate carcinoma. Median survival from presentation with brain metastases to death was 5 months for patients with single lesions and 3 months for patients with multifocal disease (P = 0.0001). Median survival for patients with a single lesion was 11 months with surgery and 3 months without surgery (P = 0.0001). Surgery did not significantly influence survival in patients with multiple metastases.
Dissemination of systemic carcinoma to the brain continues to carry a poor prognosis. Knowledge of the metastatic patterns and limited survival associated with specific tumor types may be useful for guiding future therapeutic intervention.
随着转移性脑癌新疗法的出现，在研究潜在治疗方案时，颅内疾病模式和影响生存的因素成为重要的考虑因素。
回顾了1973年至1993年期间接受治疗的729例脑转移患者的记录。
原发肿瘤组织学类型按频率从高到低依次为非小细胞肺癌（NSCLC）、乳腺癌、小细胞肺癌（SCLC）、恶性黑色素瘤、肾细胞癌、胃肠道癌、子宫/外阴癌和原发癌不明。有384例患者（53%）有单个脑转移灶，最常见于前列腺癌患者，最少见于小细胞肺癌患者。345例患者（47%）有多个转移灶。从诊断到出现脑转移的中位时间为12个月，非小细胞肺癌患者为3个月，乳腺癌患者为53个月。从出现脑转移到死亡的中位时间为4个月，小细胞肺癌患者为3个月，前列腺癌患者为13个月。单个病灶患者从出现脑转移到死亡的中位生存期为5个月，多灶性疾病患者为3个月（P = 0.0001）。单个病灶患者手术的中位生存期为11个月，未手术的为3个月（P = 0.0001）。手术对多发转移患者的生存没有显著影响。
系统性癌转移至脑的预后仍然很差。了解与特定肿瘤类型相关的转移模式和有限生存期可能有助于指导未来的治疗干预。
