脑膜转移癌患者的临床特征及预后因素分析  

Clinical features and prognostic factors in patients with leptomeningeal metastases

作　　者：李宁[1] 杨渤彦[1] 李峻岭[2] 朱继庆[1] 邹宝华[1] 王延风[1] 于雷[1] 姚晓英[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院综合科,100021 [2]中国医学科学院北京协和医学院肿瘤医院 内科,100021

出　　处：《中华肿瘤杂志》2013年第11期867-870,共4页Chinese Journal of Oncology

摘　　要：目的探讨脑膜转移癌（LM）患者的临床特点和治疗方法，并进行预后因素分析。方法回顾性分析2002年12月至2011年12月间77例LM患者的临床特征和随访资料，采用Kaplan—Meier法绘制生存曲线，并分析影响LM患者预后的因素。结果77例LM患者的中位生存时间为88d，1年生存率为14．3％（11／77）。单因素分析显示，KPS评分、原发肿瘤控制情况和全身治疗情况与LM患者的生存时间有关（均P〈0．05），全身治疗组和未全身治疗组患者的中位生存时间分别为150d和60d（P=0．001）。全身治疗联合局部治疗（脑脊膜放疗或鞘内化疗）可进一步提高患者的生存时间。多因素分析显示，近期疗效和KPS评分是影响LM患者预后的独立因素（均P〈0．05）。结论KtXS评分和近期疗效是影响LM患者的独立预后因素。全身化疗和（或）靶向治疗可提高LM患者的生存时间，建议首选全身系统治疗（包括全身化疗、靶向治疗）为基础的治疗方案，根据患者具体情况，全身治疗联合全脑放疗或鞘内注射可进一步改善患者预后。Objective To investigate the clinical characteristics and prognostic factors of leptomeningeal metastases （LM） from solid tumors and to develop better treatment strategies. Methods The clinical characteristics and follow-up results of 77 cases of leptomeningeal metastases （ LM ） from solid tumors diagnosed and treated in our hospital from 2002 to 2011 were retrospectively analyzed. Clinical characteristics, treatment methods and overall survival were analyzed using Kaplan-Meier method and Cox regression model. Results The median survival time for all the patients was 88 days. KPS score, control of the primary tumor and systemic treatment were correlated with survival time for the patients （P 〈 0.05 for all）. The median survival time of systemic treatment was 150 d and those without systemic treatment （chemotherapy and/or targeted therapy） after LM was 60 d （P = 0.001 ）. Systemic therapy combined with local treatment （ radiotherapy to the meninges or intrathecal chemotherapy） further improved the survival time of patients. Multivariate analysis showed that KPS and short-term therapeutic response for the LM were independent prognostic factors （ P 〈 0.05 for both）. Conclusions KPS and short-term therapeutic response are independent prognostic factores for leptomeningeal metastases from solid tumors. Systemic chemotherapy or targeted therapy can prolong the survival time. Systemic treatment （chemotherapy and/or targeted therapy） combined with radiation therapy or intrathecal injection may further improve the clinical outcomes.

关 键 词：脑肿瘤 肿瘤转移 药物疗法 放射疗法 预后 

分 类 号：R739.4[医药卫生—肿瘤]