局部进展期直肠癌根治性手术后继发脑转移瘤的临床特征及预后分析  

Clinical characteristics and prognosis of brain metastasis in locally advanced rectal cancer

作　　者：李干斌 张潇 王晨童 邱小原 张冠南 牛备战 徐徕 陆君阳 吴斌 肖毅[1] 林国乐 Li Ganbin;Zhang Xiao;Wang Chentong;Qiu Xiaoyuan;Zhang Guannan;Niu Beizhan;Xu Lai;Lu Junyang;Wu Bin;Xiao Yi;Lin Guole(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院基本外科,北京100730

出　　处：《中华胃肠外科杂志》2024年第10期1063-1068,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：中央高水平医院临床科研专项(No.2022-PUMCH-C-005、No.2022-PUMCH-B-005)。

摘　　要：目的探讨局部进展期直肠癌(LARC)根治性手术后继发脑转移瘤的临床特征。方法采用描述性病例研究方法,回顾性分析2013—2023年北京协和医院基本外科诊治的LARC继发脑转移瘤患者的临床资料。纳入标准为肿瘤下缘距肛缘15 cm以内并接受根治性手术的直肠腺癌患者;排除原发脑肿瘤者。主要结局指标是总体生存率(OS)和无病生存率(DFS)以及疾病特异性生存时间(即从发生脑转移到出现任何原因导致死亡的时间间隔)。采用Kaplan-Meier法绘制生存曲线。结果共计LARC患者4500例,其中20例(0.4%)发生脑转移。发生脑转移时的年龄(63.8±9.3)岁,女性5例,男性15例。4例脑转移为首发,孤立性脑转移瘤18例,多发性2例。转移瘤位于小脑10例,位于额叶7例,双侧大脑2例,左基底节1例。18例合并异时性颅外转移。主要临床表现为头晕头痛5例,突发肢体无力4例,突发言语不利和复视各2例,3例为复查时发现,还有4例无特异性表现。治疗措施包括手术切除6例,联合放化疗9例,姑息性治疗5例。随访截至2023年10月,中位随访时间45.5(4~112)个月。1、3和5年OS分别为95.0%、62.9%和43.3%;1、3和5年DFS分别为55.0%、25.0%和5.0%。疾病特异性生存时间仅为16(10.2~21.8)个月。结论LARC继发脑转移发生率低,常合并多部位异时性颅外转移,以男性多见,临床表现无特异性,手术治疗或联合放化疗可在一定程度上改善疾病特异性生存时间,但总体生存预后较差。Objective To investigate the clinical characteristics of brain metastases after radical surgery for locally advanced rectal cancer(LARC).Methods The clinical characteristics of LARC with brain metastases treated in the Department of General Surgery,Peking Union Medical College Hospital from 2013 to 2023 were retrospectively analyzed.The inclusion criteria were rectal adenocarcinoma within 15 cm of the anal verge and having undergone radical surgery,and the exclusion criterion was primary malignant tumor of the brain.The main outcomes were overall survival(OS),disease-free survival(DFS),and disease-specific overall survival(determined as the interval between occurrence of brain metastasis to death from any causes).The Kaplan–Meier method was used for survival analysis.Results We identified 4500 patients with LARC,20(0.4%)of whom had brain metastases.The mean age of patients with brain metastases was 63.8±9.3 years.They comprised five women and 15 men.The brain was the first site of metastasis in four patients(20%)whereas 18 patients had heterochronous extracranial metastases before brain metastasis.Two patients also had multi-organ metastases.The most common manifestations of brain metastases were dizziness and headache(five patients,25%),sudden onset of limb weakness(four,20%),sudden speech impairment(two,10%),and polyopia(two,10%).The metastases were diagnosed during follow-up in three patients(15%).Four of the patients were asymptomatic(20%).Treatment approaches included surgical resection(six patients,30%),chemoradiotherapy(nine,45%),and palliative(five,25%).The median follow-up time was 45.5(4–112)months until October 2023.1y-OS,3y-OS,and 5y-OS were 95.0%,62.9%,and 43.3%,respectively.1y-DFS,3y-DFS,and 5y-DFS were 55.0%,25.0%,and 5.0%,respectively.With brain metastasis as the starting point,the median duration of survival was 16(10.2–21.8)months.Conclusion The incidence of brain metastasis is relatively low in patients with LARC,who often have multiple synchronous extracranial metastases.Brain metastase

关 键 词：直肠肿瘤 局部进展期 根治性手术 继发性脑转移瘤 临床特征 预后 

分 类 号：R735.37[医药卫生—肿瘤]