102例老年脑转移肿瘤患者的临床预后分析

Prognostic analysis of 102 elderly cancer patients with brain metastases

目的 探讨影响老年脑转移肿瘤患者预后的相关因素,研究脑转移肿瘤回归分割分析（RPA）及预后评估量表（GPA）的适应性,对老年脑转移瘤患者的预后评估及治疗提供依据. 方法 回顾性分析我院2005年1月至2012年1月收治的有完整随访资料的102例老年脑转移瘤患者（年龄≥60岁）,用Kaplan-Meier方法进行生存率分析,Log-rank检验对民族、年龄、卡氏评分、性别、吸烟、原发肿瘤来源、颅内转移瘤个数、伴有颅外转移、原发灶近期疗效、脑转移瘤治疗方式进行单因素预后分析,Cox回归模型进行多因素预后分析. 结果 中位生存期为6个月,6个月、12个月生存率分别为54.90％、16.67％.单因素分析结果显示,卡氏评分、吸烟、脑转移瘤个数、脑转移确诊至治疗时间、原发灶疗效及伴有其他基础疾病是老年脑转移瘤患者的预后因素（Ⅹ^2=20.828、5.737、7.395、5.379、11.556、6.844,均P＜0.05）.Cox多因素回归分析结果显示,卡氏评分、脑转移瘤个数、原发灶疗效及合并其他基础疾病为其预后的独立影响因素（均P＜0.05）.RPA分类Ⅰ、Ⅱ、Ⅲ类中位生存期分别为11、7、4个月,生存期差异有统计学意义（Ⅹ^2=27.358,P＜0.001）;GPA Ⅰ、Ⅱ、Ⅲ-Ⅳ类中位生存期分别为5、8、13个月,生存期差异有统计学意义（Ⅹ^2=29.570,P＜0.001）. 结论 卡氏评分、脑转移瘤个数、原发灶疗效及合并其他基础疾病是影响老年脑转移肿瘤患者预后的独立因素.RPA及GPA分类在老年脑转移瘤患者中有较好的适应性.

Objective To explore the related factors for the prognosis in elderly cancer patients with cerebral metastases,to study the adaptability of brain metastasis in recursive partitioning analysis （RPA）and the prognosis Assessment （GPA） Scale,in order to provide the basis for the prognosis assessment and treatment in the elderly patients with brain metastasis.Methods A retrospective analysis was studied in 102 elderly cancer patients with brain metastasis （aged 60 years and over） with complete follow-up data in our hospital from January 2005 to January 2012.Survival analysis was performed by using the Kaplan-Meier method.Univariate analysis of ethnicity,age,Karnofsky score,gender,smoking,primary tumor origin,the number of intracranial metastatic tumor,intracranial and extracranial metastasis,the efficacy of treatment for primary tumor,the treatment of brain metastases were analyzed by Log-rank test.Results The median survival time was 6 months.The 6-month and 12-month survival rates were 54.90% and 16.67% respectively.Univariate analysis showed that Karnofsky score,smoking,the number of intracranial metastatic tumor,time to diagnosis and treatment,the efficacy of treatment for primary tumor and other underlying diseases were the relative factors for prognosis of elderly cancer patients with brain metastases （Ⅹ^2 =20.828,5.737,7.395,5.379,11.556,6.844,all P〈0.05）.Cox multivariate regression analysis showed that the Karnofsky score,the number of intracranial metastatic tumor,the efficacy of treatment for primary tumor and other underlying diseases were the independent prognostic factors （all P〈0.05）.The median survival periods in RPA class Ⅰ,Ⅱ,Ⅲ were 11,7,4 month respectively （Ⅹ^2 =27.358,P〈0.001）.The median survival periods in GPA class Ⅰ,Ⅱ,Ⅲ-Ⅳ were 5,8,13 months respectively （Ⅹ^2 =29.570,P〈0.001）.Conclusions Karnofsky score,the number of intracranial metastatic tumor,the efficacy of treatment for primary tumor and other underlying diseases are the independent factors for the prognosis in elderly cancer patients with cerebral metastases.RPA and GPA classification have a good adaptability in elderly patients with brain metastases.