脑膜转移癌58例预后因素分析

Prognostic factors in 58 patients with leptomeningeal metastases

目的探讨脑膜转移癌(leptomeningeal metastases,LM)的临床特征及治疗方法,并进行预后因素分析。方法回顾性分析天津医科大学肿瘤医院2005-01-01-2014-01-01收治的58例脑膜转移癌患者的临床资料,采用Kaplan-Meier法进行单因素生存分析,用Cox回归模型分析患者生存的预后因素。结果 58例脑膜转移癌患者的中位生存时间为4.5个月,1年生存率为15.5%(9/58)。单因素分析结果表明,KPS评分≥70(χ2=7.741,P=0.005)、局部化疗(χ2=4.991,P=0.025)、全身治疗(χ2=12.640,P<0.001)、治疗方式(χ2=17.039,P<0.001)和近期疗效(χ2=27.970,P<0.001)与患者的预后相关。在颅内压增高组中,脑室腹腔分流术与患者的预后相关,χ2=4.266,P=0.039;肺癌亚组中,靶向治疗患者预后优于未行靶向治疗的患者,χ2=14.316,P<0.001。多因素分析结果表明,KPS评分(P=0.026)、全身治疗(P=0.049)和近期疗效(P<0.001)是影响LM患者预后的独立因素。结论脑膜转转移癌总体预后较差,但是KPS评分≥70者、近期疗效为有效者预后较好,积极的全身治疗可以使患者获得到最大程度的生存受益。

OBJECTIVE To investigate clinical features and prognostic factors in patients with leptomeningeal metastases（LM）and discuss better treatment strategy for LM.METHODS Single center data on characteristics,treatment and outcome of 58 cases of LM between 1st Jan.2005 and 1st Jan.2014 were analyzed retrospectively.Survival and prognosis were analyzed by Kaplan-Meier method and Cox regression model.RESULTS The median survival time for all the patients was 4.5months.The 1-year overall survival rate was 15.5%（9/58）.Univariate analysis revealed that KPS score≥70（χ2=7.741,P=0.005）,local chemotherapy（χ2=4.991,P=0.025）,systemic treatment（χ2=12.640,P〈0.001）,treatment methods（χ2=17.039,P〈0.001）and treatment response（χ2=27.970,P〈0.001）were related to the prognosis.The patients with intracranial hypertension performed ventriculoperitoneal shut had a better prognosis（χ2=4.266,P=0.039）.EGFR-TKI therapy improved outcomes of LM in lung cancer patients（χ2=14.316,P〈0.001）.Multivariate analysis indicated that KPS score（P=0.026）,systemic treatment（P=0.049）and treatment response（P〈0.001）were the independent prognostic factors.CONCLUSIONS The patients with LM have poor outcome,but those patients with KPS score≥70or response to the early treatment have better prognosis.Systemic treatment could improve the overall survival of the patients with LM.