Nguyen L N, Maor M H, Oswald M J
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1998 Nov 15;83(10):2181-4. doi: 10.1002/(sici)1097-0142(19981115)83:10<2181::aid-cncr17>3.0.co;2-j.
The prognosis of patients with brain metastasis as the only manifestation of an undetected primary tumor generally is considered to be poor. Therefore, most treatment is palliative. The authors reviewed the clinical outcomes and treatment results of patients presenting with brain metastasis from an undetected primary tumor at The University of Texas M. D. Anderson Cancer Center.
Between 1977-1996, 220 patients were referred to the study department for the treatment of brain metastasis from an undetected primary tumor. The patients' records were reviewed to identify those for whom brain metastasis was the only manifestation of the primary tumor. The majority of patients were excluded from the current analysis because extracranial metastasis also were present. Thirty-nine patients qualified for this retrospective review. The level of neurosurgical excision varied, but all patients received radiotherapy. Tumor control in the brain and survival were analyzed by various tumor-related and treatment-related factors.
In 31 patients, the brain metastasis were adenocarcinomas, whereas the remaining patients had tumors of various other histologies. In 12 patients, the primary tumor eventually was found, most commonly in the lung. The median survival time for all patients was 13.4 months. Overall survival rates (OS) at 1, 3, and 5 years were 56%, 19%, and 15%, respectively. Intracranial disease control was 72% at 5 years. Patients who received gross total resection (GTR) and radiotherapy had significantly better OS than patients who received radiotherapy alone. The OS of patients whose primary tumor was identified was similar to that of patients in whom the primary tumor remained occult.
Brain metastasis as the only manifestation of an unknown primary tumor is a distinct clinical entity. The prognosis for patients with this presentation is better than that of patients with brain metastasis in general. Although the majority of patients die of extracranial disease, a few will achieve long term survival. Treatment to the brain is effective in controlling local disease; aggressive treatment with GTR and radiotherapy is recommended.
以脑转移作为未被发现的原发性肿瘤的唯一表现的患者，其预后通常被认为较差。因此，大多数治疗都是姑息性的。作者回顾了得克萨斯大学MD安德森癌症中心以未被发现的原发性肿瘤出现脑转移的患者的临床结局和治疗结果。
在1977年至1996年期间，220例患者因未被发现的原发性肿瘤出现脑转移而被转诊至研究科室进行治疗。回顾患者记录以确定那些脑转移是原发性肿瘤唯一表现的患者。由于也存在颅外转移，大多数患者被排除在当前分析之外。39例患者符合此项回顾性研究。神经外科切除的程度各不相同，但所有患者均接受了放疗。通过各种肿瘤相关和治疗相关因素分析脑内肿瘤控制情况和生存率。
31例患者的脑转移瘤为腺癌，其余患者有各种其他组织学类型的肿瘤。12例患者最终发现了原发性肿瘤，最常见于肺部。所有患者的中位生存时间为13.4个月。1年、3年和5年的总生存率（OS）分别为56%、19%和15%。5年时颅内疾病控制率为72%。接受全切除（GTR）和放疗的患者的OS明显优于单纯接受放疗的患者。原发性肿瘤被确定的患者的OS与原发性肿瘤仍隐匿的患者相似。
以脑转移作为未知原发性肿瘤的唯一表现是一种独特的临床实体。有此表现的患者的预后优于一般脑转移患者。尽管大多数患者死于颅外疾病，但少数患者将实现长期生存。针对脑部的治疗在控制局部疾病方面是有效的；建议采用GTR和放疗进行积极治疗。
