37例手术治疗小脑转移瘤预后因素分析

Analysis of prognostic factors of surgery for cerebellar metastasis in 37 patients

目的探讨经手术治疗小脑转移瘤病人预后生存的影响因素、手术适应证选择及综合治疗意义。方法回顾性分析37例经手术治疗的小脑转移瘤病人的临床资料,统计分析病人预后生存的影响因素。结果全切除28例(75.7%),次全切除9例(24.3%),无死亡病例。中位生存期11个月。单因素生存分析结果显示:术前KPS评分(χ^2=8.412,P=0.004)、原发灶稳定情况(χ^2=6.482,P=0.011)、是否合并幕上转移(χ^2=4.118,P=0.042)或颅外转移(χ^2=39.358,P=0.000)、肿瘤是否全切(χ^2=5.006,P=0.025)、术后辅助放化疗(χ^2=8.834,P=0.003)对小脑转移瘤病人术后生存有影响。年龄、性别、原发肿瘤部位对生存期无影响(P>0.05)。多因素分析显示:术前颅外转移(P=0.049)和术后辅助放化疗(P=0.019)为独立影响因素。结论对于术前合并颅外转移的小脑转移瘤病人,选择手术切除应慎重,术中尽量做到肿瘤全切,术后积极辅助性放化疗可有效延长病人生存期。

Objective To investigate the prognostic and survival factors,selection of surgical indications and significance of comprehensive treatment of the patients after surgery for cerebellar metastasis.Methods Clinical data of 37 patients after surgery for cerebellar metastasis were analyzed retrospectively.The prognostic and survival factors were analyzed statistically.Results Total metastasis resection was achieved in 28 patients(75.7%)and subtotal resection in 9(24.3%).There was no death.The median survival time was 11 months.The univariate survival analysis results showed that preoperative KPS score(χ^2=8.412,P=0.004),stable condition of primary lesion(χ^2=6.482,P=0.011),whether combined with supratentorial metastasis or not(χ^2=4.118,P=0.042)or extracranial metastasis(χ^2=39.358,P=0.000),whether total tumor resection or not(χ^2=5.006,P=0.025),postoperative adjuvant radiotherapy and chemotherapy(χ^2=8.834,P=0.003)were the influencing factors affecting the postoperative survival of patients with cerebellar metastasis.Age,gender and location of primary tumor had no influence on survival time(P>0.05).Multivariate analysis results showed that preoperative extracranial metastasis(P=0.049)and postoperative adjuvant radiotherapy and chemotherapy(P=0.019)were independent factors.Conclusions For cerebellar metastasis patients with extracranial metastasis before surgery,surgical resection should be choosen carefully,total tumor resection should be achieved as far as possible during surgery,and active adjuvant radiotherapy and chemotherapy after surgery can effectively prolong the survival time.