Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery Clinical article
Tumor volume as a predictor of survival and local control in patients with brain metastases treated with Gamma Knife surgery Clinical article
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DOI：
10.3171/2013.7.jns13431
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发表时间：
2013-11-01
影响因子：
4.1
通讯作者：
Grills, Inga Siiner
中科院分区：
文献类型：
--
作者：
Baschnagel, Andrew M.;Meyer, Kurt D.;Grills, Inga Siiner
对象。本研究的目的是探讨肿瘤体积作为伽玛刀手术（GKS）脑转移患者预后的影响因素。我们对250例1-14脑转移患者进行了回顾性研究，这些患者最初在一家机构单独接受了GKS治疗。预先接受全脑放疗的患者被排除在外。使用Kaplan-Meier法估计生存时间。采用Cox比例风险回归模型进行单因素和多因素分析，以确定各种预后因素是否可以预测总生存率、远端脑衰竭和局部控制。中位总生存期为7.1个月，1年局部控制率为91.5%。发生远端脑衰竭的中位时间为8.0个月。在单因素分析中，肿瘤总体积的增加与更差的生存率显著相关（p = 0.031），而脑转移的数量，作为一个连续变量分析，则没有（p = 0.082）。在多变量分析中调整年龄、Karnofsky表现量表评分和颅外疾病后，发现肿瘤总体积是总生存的更好预测因子（p = 0.046），而脑转移数量作为连续变量分析（p = 0.098）。肿瘤总体积临界值>= 2 cm(3) （p = 0.008）比脑转移数（p = 0.098）更能预测总生存率。在多变量分析中，较大的肿瘤体积和颅外疾病，而不是脑转移的数量，是远处脑衰竭的预测因素。病变< 2 cm(3)的1年局部肿瘤控制率为97%，而病变≤2 cm(3)的1年局部肿瘤控制率为75% （p < 0.001）。在调整了其他因素后，即使考虑到转移的数量，总脑转移体积也是总体生存、远端脑衰竭和局部控制的一个强大而独立的预测因子。
Object. The aim of this study was to examine tumor volume as a prognostic factor for patients with brain metastases treated with Gamma Knife surgery (GKS).Methods. Two hundred fifty patients with 1-14 brain metastases who had initially undergone GKS alone at a single institution were retrospectively reviewed. Patients who received upfront whole brain radiation therapy were excluded. Survival times were estimated using the Kaplan-Meier method. Univariate and multivariate analyses using Cox proportional hazard regression models were used to determine if various prognostic factors could predict overall survival, distant brain failure, and local control.Results. Median overall survival was 7.1 months and the 1-year local control rate was 91.5%. Median time to distant brain failure was 8.0 months. On univariate analysis an increasing total tumor volume was significantly associated with worse survival (p = 0.031) whereas the number of brain metastases, analyzed as a continuous variable, was not (p = 0.082). After adjusting for age, Karnofsky Performance Scale score, and extracranial disease on multivariate analysis, total tumor volume was found to be a better predictor of overall survival (p = 0.046) than number of brain metastases analyzed as a continuous variable (p = 0.098). A total tumor volume cutoff value of a >= 2 cm(3) (p = 0.008) was a stronger predictor of overall survival than the number of brain metastases (p = 0.098). Larger tumor volume and extracranial disease, but not the number of brain metastases, were predictive of distant brain failure on multivariate analysis. Local tumor control at 1 year was 97% for lesions < 2 cm(3) compared with 75% for lesions a 2 cm(3) (p < 0.001).Conclusions. After adjusting for other factors, a total brain metastasis volume was a strong and independent predictor for overall survival, distant brain failure, and local control, even when considering the number of metastases.