Radiotherapy or systemic therapy versus combined therapy in patients with brain metastases: a propensity-score matched study
Radiotherapy or systemic therapy versus combined therapy in patients with brain metastases: a propensity-score matched study
复制标题
DOI：
10.1007/s11060-022-04132-2
复制
发表时间：
2022-09
影响因子：
3.9
通讯作者：
Y. Koide;N. Nagai;R. Miyauchi;T. Kitagawa;T. Aoyama;H. Shimizu;H. Tachibana;T. Kodaira
中科院分区：
文献类型：
--
作者：
Y. Koide;N. Nagai;R. Miyauchi;T. Kitagawa;T. Aoyama;H. Shimizu;H. Tachibana;T. Kodaira
目的评价系统治疗(ST)联合立体定向放射外科(SRS)治疗脑转移瘤的临床疗效。排除手术和全脑放射治疗病例和卡诺夫斯基功能状态差(Kps <； 70)。将符合条件的患者分为单一治疗(SRS或单独ST)和联合治疗(SRS和ST，1个月内联合治疗)。使用单变量和多变量COX比例风险分析来检查与死亡风险增加和颅内进展相关的因素。根据现有的预后协变量计算选择治疗的倾向评分。两组病例按1：1比例配对，比较两组患者的颅内无进展生存期(PFS)和总生存期(OS)。结果共确定1605例患者，分析928例患者(单药治疗：N = 494，联合治疗：N = 434)。在多变量模型中，与单一治疗相比，联合治疗独立地与PFS和OS的改善相关。在匹配的数据集中，中位数为3830天的随访中，联合治疗组的PFS(中位数，7.4vs.5.0个月，P<； 0.001)和OS(中位数，23.1个月，17.2个月，P= 0.036)显著长于单一治疗组。联合治疗组的总体颅内进展和死亡风险降低，估计HR分别为0.70和0.78。结论联合治疗的BM患者的PFS和OS比单一治疗更长。这些结果支持了最近将全身疗法和局部疗法结合起来的趋势，鼓励未来的临床试验。
AimThis study aimed to evaluate the clinical benefits of systemic therapy (ST) combined with stereotactic radiosurgery (SRS) for brain metastases (BM).MethodsThe patient data were extracted from the institutional disease database from 2016 to 2021. Surgical and whole-brain radiotherapy cases and poor Karnofsky performance status (KPS < 70) were excluded. The eligible patients were divided into monotherapy (SRS alone or ST alone) and combined therapy (SRS and ST, combined within a month). Univariate and multivariate Cox proportional hazards analyses were used to examine factors associated with increased risk of death and intracranial progression. The propensity score for selecting treatment was calculated based on existing prognostic covariates. Two groups were matched 1:1 and compared for intracranial progression-free survival (PFS) and overall survival (OS).ResultsWe identified 1605 patients and analyzed 928 (monotherapy: n = 494, combined therapy: n = 434). In a multivariable model, the combined therapy was independently associated with improved PFS and OS relative to the monotherapy. At the median follow-up of 383 days in the matched dataset, the combined therapy group showed significantly longer PFS (median, 7.4 vs. 5.0 months,P< 0.001) and OS (median, 23.1 vs. 17.2 months,P= 0.036) than the monotherapy group. The overall intracranial progression and mortality risk was reduced in the combined therapy group, with an estimated HR of 0.70 and 0.78.ConclusionsCombined therapy exhibited longer PFS and OS than monotherapy in BM patients. The results support the recent trend toward combining systemic and local therapies, encouraging future clinical trials.