摘要
目的旨在探索黑色素瘤脑转移的临床特点及其对生存期的影响。方法回顾性地分析2009—2019年间北京大学肿瘤医院肾癌黑色素瘤内科收治的黑色素瘤脑转移患者临床资料,分析临床特点和生存情况。脑转移的局部治疗包括手术、立体定向放疗和全脑放疗。全身治疗手段则分为化疗、靶向治疗(BRAF抑制剂)及免疫治疗(免疫检查点抑制剂)。Kaplan-Meier法计算患者生存率和生存时间并log-rank检验和单因素预后分析,Cox模型多因素预后分析。结果共计271例患者被纳入本项分析中,其中男占55.4%,全组患者中位年龄52岁(范围16~82岁)。有50.2%患者发现脑转移时乳酸脱氢酶水平高于正常,25.5%的患者颅外转移器官数≥3,24.7%的患者并发肝转移。诊断时有50.2%的患者伴有中枢神经系统症状。随访至2020年4月,脑转移患者的中位生存时间9.1个月(95%CI为7.7~10.5个月),1、2年总生存率分别为38.0%(95%CI为36.0%~44.0%)、11.0%(95%CI为9.0%~15.0%)。与脑转移生存期相关的危险因素包括有中枢神经系统症状的脑转移、乳酸脱氢酶大于正常上限以及并发肝转移(均P<0.05)。结论黑色素瘤脑转移预后差,发现脑转移后中位总生存期短。有症状的脑转移、乳酸脱氢酶大于正常上限以及并发肝转移是黑色素瘤脑转移总生存的不良预后因素。
Objective To explore the clinical features and survival of melanoma brain metastases.Methods Retrospectively analyzed patients with brain metastases admitted to Peking University Cancer Hospital from 2009 to 2019,clinical data and survival information were extracted form medical records retrospectively.Local treatment of brain metastases includes surgery,stereotactic radiotherapy and whole brain radiotherapy.Systemic therapy includes chemotherapy,targeted therapy(BRAF inhibitors)and immunotherapy(immunosuppressive checkpoint inhibitors).Kaplan Meier method was used to calculate the survival rate and survival time.The log-rank test and univariate prognostic analysis were performed.Multivariate prognostic analysis was performed with Cox model.Results A total of 271 patients were included in this analysis,of which 55.4%were male,with a median age of 52 years(16~82 years).50.2%of patients had elevated LDH level during brain metastasis,25.5%of patients had extracranial metastasis organ sites of 3 or more,and 24.7%of patients had liver metastasis.At the time of brain metastasis diagnosis,50.2%of patients were accompanied by symptoms of brain metastasis.The median overall survival for brain metastases was 9.1 months(95%CI:7.7~10.5 months),and the 1-and 2-year overall survival rate were 38.0%(95%CI:36.0%~44.0%)and 11.0%(95%CI:9.0%~15.0%),respectively.Risk factors related to the survival of brain metastases include symptomatic brain metastases,elevated LDH level,and concurrent liver metastases(all P values<0.05).Conclusions The prognosis of melanoma brain metastases is poor,and the median overall survival for brain metastases is found to be short.The patients with symptomatic brain metastases,elevated LDH level,and concurrent liver metastases are independent adverse prognostic factors for overall survival of melanoma brain metastases.
作者
毛丽丽
白雪
齐忠慧
李彩莉
盛锡楠
崔传亮
迟志宏
唐碧霞
王轩
连斌
鄢谢桥
周莉
斯璐
郭军
Mao Lili;Bai Xue;Qi Zhonghui;Li Caili;Sheng Xinan;Cui Chuanliang;Chi Zhihong;Tang Bixia;Wang Xuan;Lian Bin;Yan Xieqiao;Zhou Li;Si Lu;Guo Jun(Department of Internal Medicine of Renal Cell Carcinoma and Melanoma,Cancer Hospital of Peking University and Beijing Institute of Cancer Prevention and Treatment,Key Laboratory of Malignant Tumor Pathogenesis and Transformation of Ministry of Education,Beijing 100142,China)
出处
《中华转移性肿瘤杂志》
2020年第2期83-86,共4页
Chinese Journal of Metastatic Cancer
基金
国家自然科学基金(81972566、81972562)
作者简介
通信作者:郭军,Email:guoj307@126.com
