脑转移瘤1448例临床资料分析

Review of 1448 Patients with Brain Metastases

背景与目的:随着医疗技术的进步,肿瘤患者生存时间延长,脑转移瘤的发病率明显上升,但总体预后还很差,关于治疗模式的选择还存在很大的争议。本文总结中山大学肿瘤防治中心脑转移瘤患者临床资料,分析疾病特点以及与预后相关的各种可能因素,旨在为脑转移瘤的诊治提供参考。方法:收集1984年1月至2010年7月在中山大学肿瘤防治中心治疗经影像学或病理诊断的脑转移瘤患者的临床资料。总结所有可能与患者预后相关的因素,包括:患者的基本信息,原发灶的诊治情况,有无脑外转移灶,原发灶与脑转移瘤诊断的间隔时间,诊断依据,临床表现,病灶大小、部位、数目,治疗方法,KPS评分等。根据上述资料,将患者纳入RPAⅠ、Ⅱ、Ⅲ级3个亚组,进行生存分析。结果:共收集到1448例脑转移瘤患者,男性953例(65.8%),女性495例(34.2%),诊断为脑转移瘤时的中位年龄为55岁。原发灶中,肺癌1173例(81.0%)、乳腺癌84例(5.8%)、结直肠癌43例(3.0%)、肝癌23例(1.6%)。457例(39.8%)患者在诊断脑转移瘤之前存在脑外转移灶,原发灶与脑转移诊断的平均间隔时间为8.7个月。898例(62.0%)患者诊断依据为颅脑MRI,524例(36.2%)为颅脑CT,26例(1.8%)为PET-CT。944例(65.2%)患者的转移灶位于幕上,其中额叶及顶叶最为常见;单发病灶522例(36%),201例(13.9%)具有两个病灶,621例(42.9%)具有两个以上病灶。临床表现中,头痛呕吐378例(26.1%),运动感觉障碍364例(25.1%),精神变差或体重下降230例(16.0%),无症状203例(14.0%)。379例(26.1%)患者接受了全脑放疗联合化疗,110例(7.6%)接受了单纯全脑放疗,23例(1.6%)全脑放疗后联合手术,42例(2.9%)联合立体定向放射外科治疗。107例(7.4%)患者接受了手术治疗。854例患者具有完整的生存随访资料,中位生存时间为9.5个月;6个月、12个月、24个月累计生存率分别为71.7%、42.5%、12.6%。RPAⅠ级264例(30.9%)、Ⅱ级377例(44.2%)、Ⅲ级213例(24.9%)3组患者的中位生存时间分别为11个月、10.5个月和6.5个月,组间差异有统计学意义(P<0.001)。结论:脑转移瘤常多发,转移灶多见于幕上,头颅MRI是主要的诊断方法;原发灶以肺癌最多见;RPA分级在评估脑转移瘤患者预后中有重要意义;坚持在循证医学指导下的个体化治疗的原则,有希望改善脑转移瘤患者的预后。

BACKGROUND OBJECTIVE： The incidence of brain metastases （BM） is increasing as a result of the prolonged survival of cancer patient and the development of imaging technology, However, how to treat brain metastases is still under controversy and the prognosis remains very poor. In this article, we analyzed the incidence and summarized the presentations and prognostic factors of brain metastases at Sun Yat Sen University Cancer Center. METHODS： From 1984 to 2010, data of patients with brain metastases diagnosed either pathologically or radiographically were retrospectively reviewed. The survival analysis was performed with Kaplan-Meier method. Prognostic factors were also analyzed. RESULTS： A total of 1448 patients were identified, including 953 males and 495 females. Themedian age at the diagnosis of brain metastases was 55 years. The most common primary site was lung. The most common neurological symptoms were headache and nausea （26.1%）, and motor weakness and paraesthesia （25.1%）. About 30% of patients were asymptomatic or with slight uncomfortable. Thirty-nine point eight percent of patients had systematic diseases before or with the diagnosis of brain metastases. The median interval between the diagnosis of primary tumor and diagnosis of BM was 8.7 months. Most of patients were confirmed with MRI （62.0%）. Thirty-six percent of patients had a single brain metastasis. Most metastases were supratentorial （65.2%）. The frontal and parietal lobes were the most common sites. The treatment modalities were various, including radiotherapy, surgical resection, and chemotherapy. The follow-up information was complete for 854 patients. The 6-month, 1-year and 2-year survival was 71.7%, 42.5% and 12.6% at 24 months, respectively, with a median survival time of 9.5 months. There was a significant difference between the RPA I, II and III groups with the median survival time were 11, 10.5 and 6.5 months respectively （P 0.001）. CONCLUSIONS： This review described the information of patients with brain metastases treated in our center. Further analysis is required to identify the potential prognostic factors of patients with brain metastases, which will be helpful for the treatment of patients with brain metastases.