多发脑转移瘤手术治疗临床病理回顾性分析  

Curative effect and prognostic factors correlated with survival among patients with surgically resected multiple brain metastases

作　　者：谈丽彩 何佳[1] 孙增峰[1] 佘春华[1] 李鹏[1] 李文良[1] 

机构地区：[1]天津医科大学肿瘤医院脑系肿瘤科.国家肿瘤临床医学研究中心.天津市肿瘤防治重点实验室,天津300060

出　　处：《中华肿瘤防治杂志》2015年第12期946-950,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨手术治疗多发脑转移瘤的临床疗效并分析影响其预后的因素。方法收集天津医科大学肿瘤医院2002-01-01-2012-12-01于我院行开颅手术治疗的62例多发脑转移瘤患者的临床资料。原发病灶明确者61例,其中肺癌32例,乳腺癌12例,消化道肿瘤6例,恶性黑色素瘤4例,生殖系统肿瘤3例,肾癌2例,甲状腺癌2例,原发灶不明1例。总结手术治疗效果及与患者预后的相关因素。结果术前有神经症状及体征的54例患者术后症状和体征消失或改善50例(92.6%),无明显改善4例(7.4%),无加重及死亡病例,术前无神经症状及体征的8例患者术后未出现手术相关神经症状和体征。生存期与生存率从脑转移诊断日起计算,中位生存期为12.0个月,1、2和3年生存率分别为54.8%、17.7%和4.8%。单因素分析显示,脑转移瘤数目(χ2=14.936,P<0.001)、颅外其他部位转移情况(χ2=6.382,P=0.012)、脑转移术前放疗与否(χ2=4.192,P=0.041)、术后化疗与否(χ2=3.397,P=0.006)、脑转移治疗分组(χ2=9.178,P=0.027)等对生存期有影响;多因素分析显示,脑转移瘤数目(P=0.001)、颅外其他部位转移情况(P=0.047)、脑转移术前放疗与否(P<0.001)、脑转移瘤的治疗分组(P=0.001)是影响多发脑转移瘤患者手术治疗的独立预后因素。手术+放化疗组中位生存期为15.0个月分别与单纯手术组的9.0个月(χ2=6.569,P=0.010)和手术+放疗组的12.0个月(χ2=7.158,P=0.007)相比差异有统计学意义。结论手术能明显缓解多发脑转移瘤患者的临床症状,提高患者的生存质量;对于原发肿瘤控制、无颅外其他部位转移、颅内转移灶数目≤3个和已行头颅放疗的多发脑转移瘤患者更能从手术中获益,手术联合放化疗等综合治疗可进一步延长患者的生存期。OBJECTIVE To explore the curative effect and to analyze the potential prognostic factors in patients with surgically resected multiple brain metastases.METHODS We collected the clinical treatment materials of multiple brain metastatic patients with surgery from January 1of 2002 to December 1of 2012,and summarized therapeutic effects and factors correlated with patients＇ prognosis.61 cases of primary tumors were clear and confirmed by biopsy or operation,including lung cancer（n=32）,breast cancer（n=12）,digestive tract cancer（n=6）,malignant melanoma（n=4）,reproductive system tumor（n=3）,renal cell carcinoma（n=2）and thyroid carcinoma（n=2）,1case of primary tumors was unclear when diagnosed brain metastases.RESULTS After surgery,50（92.6%）from 54（92.6%）cases had preoperative neurologic symptoms and signs disappeared or improved,4cases had no obviously improvement（7.4%）,there was no aggravating or death cases,8cases that without preoperative neurological symptoms and signs revealed no nervous signs and symptoms after the operation.Calculated from diagnosis of brain metastases,the median survival time was 12.0 months,with 1-year,2-year,3-year survival percentages of 54.8%,17.7%,4.8%respectively.Univariate analysis showed that the independent prognostic factors for patients with multiple brain metastases treated by surgery were number of brain metastases（P〈0.001）,extracranial metastasis status（P=0.012）,preoperative radiotherapy（P=0.041）,postoperative chemotherapy（P=0.006）and the therapy of brain metastases（P=0.027）.Multivariate analysis showed that the number of brain metastases（P=0.001）,extracranial metastasis status（P=0.047）,preoperative radiotherapy（P〈0.001）and the therapy of brain metastases（P=0.001）were the independent prognostic factors.Surgery combined with chemoradiotherapy group had a 15.0months＇ median survival time,whith was significantly different compared to simple surgical group that with a 9.0months＇ time（χ^2=6.569,P=0.010

关 键 词：多发脑转移瘤 手术治疗 单因素预后分析 多因素预后分析 综合治疗 

分 类 号：R739.41[医药卫生—肿瘤]