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结直肠癌脑转移的临床特点和预后
作者:李博  白日星  李有国  邱晓光 
单位:首都医科大学附属北京天坛医院放疗科  北京 100050 首都医科大学附属北京天坛医院普外科  北京 100050 
关键词:结直肠肿瘤/外科学 脑肿瘤/外科学 脑肿瘤/继发性 肿瘤转移 放射疗法 药物疗法 回顾性研究 随访研究 
DOI:R735.3;R730.56
出版年,卷(期):页码:2017,32(5):416-420
摘要:

目的 探讨结直肠癌脑转移的临床特点及预后。方法 筛选1714例结直肠癌患者中脑转移病例36例,对其临床资料进行回顾性分析。结果 结直肠癌患者中脑转移2.1%(36/1714),占同期脑转移病例的3.3%。患者多为男性(21/36,58.3%)、直肠癌(19/36,52.8%)和诊断时分期为Ⅲ和Ⅳ期者(32/36,88.9%)。其中分期是无脑转移生存的独立预后因素(HR=2.072,P=0.042)。单发脑转移占55.6%(20/36)。94.4%(34/36)的患者在发生脑转移的同时伴有颅外转移,其中肺是最常见的伴随转移器官(22/36,61.1%)。递归分级分析(recursive partitioning analysis,RPA)分级为Ⅰ、Ⅱ和Ⅲ级患者的中位脑转移后生存时间分别为未达到、17个月和3个月(P=0.002)。多因素分析显示,脑转移时患者的卡氏(Karnofsky performance status,KPS)评分是脑转移后生存的独立预后因素(HR=8.797,P=0.044),而放化疗未发现可改善脑转移患者的预后。结论 结直肠癌脑转移发生率较低,RPA是评估患者预后的重要指标,脑转移后放化疗未改善患者的预后。

Objective To analyze the clinical characteristics and prognosis of brain metastasis (BM) in patients with colorectal carcinoma (CRC). Methods Total 1 714 cases of colorectal cancer were collected and patients with BM were screened.Clinical data of 36 CRC cases with BM were retrospectively analyzed. Results In all screened CRC patients,those with BM accounted for 2.1% (36/1 714),which represented 3.3% of BM patients during the study time period.Among 36 cases,there were 21 males (58.3%),19 cases of rectal cancer (52.8%) and 32 cases of stage Ⅲ and Ⅳ (88.9%).Staging was an independent factor of brain-metastasis-free survival (HR=2.072,P=0.042).Moreover,55.6% of patients (20/36) had single BM lesion,and 94.4% of patients (34/36) also had extracranial metastases,of which lung was the most common metastatic organ (22/36,61.1%).The median post-brain-metastasis survival (PBMS) times for patients with recursive partitioning analysis (RPA) class Ⅰ,Ⅱ and Ⅲ were not reached,17 months and 3 months,respectively (P=0.002).Multivariate analysis showed that Karnofsky performance status (KPS) score of patients upon the identification of BM was an independent prognostic factor of PBMS (HR=8.797,P=0.044).However,post-BM radiation therapy and/or chemotherapy were not found to improve patients' prognosis. Conclusion The incidence of BM is low in CRC patients.RPA is a valuable prognostic index.Post-BM radiotherapy and/or chemotherapy may have no effect on improving prognosis.

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