Surgical outcome and graded prognostic assessment of patients with brain metastasis from adult sarcoma: multi-institutional retrospective study in Japan
Surgical outcome and graded prognostic assessment of patients with brain metastasis from adult sarcoma: multi-institutional retrospective study in Japan
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DOI：
10.1007/s10147-020-01740-8
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发表时间：
2020-07-09
影响因子：
3.3
通讯作者：
Narita, Yoshitaka
中科院分区：
文献类型：
--
作者：
Deguchi, Shoichi;Nakasu, Yoko;Narita, Yoshitaka
背景脑转移瘤（BM）是肉瘤的一种少见并发症，预后差.关于从肉瘤中切除BM的可行性和预后因素的信息很少。方法本研究回顾性分析了22例肉瘤BM患者，他们在日本的六个研究所接受了切除术。使用对数秩检验和考克斯回归分析分析预后因素，以制定分级预后评估（GPA）。为了验证该GPA，我们从48份已发表的报告中收集了100例手术病例的数据。结果50%的患者术后KPS改善。中位总生存期（OS）为21个月。多因素分析显示年龄和腺泡状软组织肉瘤是影响预后的重要因素（P < 0.05）。RTOG-RPA分型对预后无显著意义。我们开发了一种用于BM切除后OS的GPA系统。18-29岁非ASPS患者的评分为0分，18-29岁ASPS或30-76岁非ASPS患者的评分为2分，30-76岁ASPS患者的评分为4分。GPA评分为0、2和4的患者的中位OS分别为6.5、16.0和44.0个月（P = 0.002）。经100例病例资料验证，P < 0.001。结论肉瘤BM患者的中位OS与癌切除后的中位OS相当。一种新的肉瘤特异性GPA可能有助于患者和临床医生选择切除术作为肉瘤BM治疗的一种选择。
Background Brain metastasis (BM) is an uncommon complication of sarcomas with a poor prognosis. Little information is available about the feasibility and prognostic factors of surgical resection of BM from sarcomas. Methods This study involved a retrospective analysis of 22 patients with BM from sarcomas who underwent resection at six institutes in Japan. Prognostic factors were analyzed to develop a graded prognostic assessment (GPA) using the log-rank test and Cox regression analysis. For validation of this GPA, we collected data on 100 surgical cases from 48 published reports. Results Postoperative Karnofsky Performance Status (KPS) improved in 50% of our patients. Median overall survival (OS) was 21 months. Multivariate analysis showed age and alveolar soft part sarcoma (ASPS) were significant preoperative prognostic factors (P < 0.05). RTOG-RPA classification had no significant prognostic value. We developed a GPA system for OS after resection of BM. A score of 0 was assigned to patients aged 18-29 years with non-ASPS, 2 to patients aged 18-29 years with ASPS or 30-76 years with non-ASPS, and 4 to patients aged 30-76 years with ASPS. Median OS for patients with GPA scores of 0, 2, and 4 were 6.5, 16.0, and 44.0 months, respectively (P = 0.002). The results were validated by the data of 100 cases compiled (P < 0.001). Conclusion Median OS of patients with BM from sarcomas was comparable to that from carcinomas after resection. A new sarcoma-specific GPA may help patients and clinicians to select resection as an option for treatment of BM from sarcomas.