妇科恶性肿瘤脑转移25例临床分析

Analysis of 25 cases of brain metastasis from gynecological cancers

目的探讨妇科恶性肿瘤脑转移患者的临床特点、治疗方法及预后影响因素。方法回顾性分析1999年1月至2009年1月收治的25例妇科恶性肿瘤脑转移患者的临床资料，比较各种治疗方法的疗效及预后影响因素。结果25例患者的原发肿瘤14例为卵巢恶性肿瘤，6例为宫颈鳞癌，5例为子宫恶性肿瘤。颅内转移病灶为单发病灶者有7例（28％，7／25）。在发现脑转移病灶的同时有18例（72％，18／25）合并有颅外病灶。诊断脑转移时患者的Kamofsky评分有14例≥70分，占56％（14／25）；有13例（52％，13／25）为病理低分化。25例患者发生脑转移后的中位生存时间为7．3个月。治疗方式：接受单一治疗（放疗或化疗）的患者有5例，平均生存时间为4．0个月（0．5—9．5个月）；16例患者接受了联合治疗，其中3例接受了包含手术的联合治疗，平均生存时间8．4个月（4．1～13．4个月），有13例接受了放疗＋化疗，平均生存时间为14．2个月（4．3—58．1个月）；4例患者仅接受姑息对症支持治疗，其生存时间仅为0．1～1．0个月。多因素分析结果显示，Karnofsky评分、是否合并颅外病灶及治疗方式是妇科恶性肿瘤脑转移患者预后的独立影响因素（P〈0．05）。结论妇科恶性肿瘤脑转移的预后差．发生率较低。治疗方面采用联合治疗能够获得相对较好的疗效。

Objective To discuss the clinical characteristics, treatment and prognostic factors of brain metastasis from gynecological cancers. Methods Clinical records of 25 brain metastasis patients from gynecological cancers admitted from January 1999 to January 2009 were reviewed retrospectively. The curative effects of different treatments were compared. The prognostic factors were determined using the Cox regression model. Results There were 14 cases ovarian malignant tumor, 6 cases cervical carcinoma and 5 cases uterine malignant tumor. Seven cases （28%, 7/25 ） had solitary metastatic lesion in the brain. Extracranial metastases were detected in 18 cases （72%, 18/25）. Five patients only received one kind of treatment, and the mean survival time was 4. 0 months （0. 5 to 9. 5 months）. Sixteen patients received combined treatment, 3 of them received combined treatment including surgery, and the mean survival time was 8.4 months （4. 1 to 13.4 months） ; 13 of them received chemotherapy and radiotherapy, and the mean survival time was 14. 2 months （4. 3 to 58.1 months）. Four patients received only palliative supportive care, and the survival time was only 0. 1 to 1.0 month. The Cox regression model showed that Karnofsky performance status scale, with or without extracranial metastases and the treatment method were the independent prognostic factors of brain metastasis from gynecological cancers （ P 〈 0. 05 ）. Conclusion The incidence of brain metastasis from gynecological cancers is low and the prognosis is very poor. Combined treatments may get better effects.