CAJ | 학술논문

目的分析大肠癌脑转移的临床特征及其手术治疗转归. 方法回顾性分析手术治疗的大肠癌伴脑转移28例患者的临床资料,统计数据采用单因素Log-Rank分析和多因素Cox回归分析法.结果大肠癌继发脑转移的中位年龄为57(41～75)岁,原发肿瘤与转移瘤间隔的中位时间为13.5个月,其中合并颅外(肺、肝、骨)转移占61%(17/28),仅有脑转移的占39%(11/28).脑转移瘤主要表现为头痛、呕吐等颅内压升高征候群和偏瘫、下肢乏力、失语等定位症状以及癫痫等,颅内转移瘤以单发病灶为多见,占82%(23/28),位于幕上(枕叶、顶叶、额叶)者占57%(16/28),位于幕下(小脑)者占43%(12/28);转移性脑瘤手术切除后中位生存时间为9.4个月,1年生存率为28.9%,5年生存率为7.1%.多因素分析提示颅内单发病灶转移(χ2=7.35,P<0.05)和无颅外其他部位转移(χ2=6.47,P<0.05)是大肠癌脑转移预后的独立影响因素.28例均接受手术切除和多学科协作治疗,无手术死亡和出血及再手术病例.结论大肠癌脑转移总体预后欠佳,手术切除脑转移病灶可延长部分患者的存活时间.
목적 분석대장암뇌전이적림상특정급기수술치료전귀. 방법회고성분석수술치료적대장암반뇌전이28례환자적림상자료,통계수거채용단인소Log-Rank분석화다인소Cox회귀분석법.결과 대장암계발뇌전이적중위년령위57(41～75)세,원발종류여전이류간격적중위시간위13.5개월,기중합병로외(폐、간、골)전이점61%(17/28),부유뇌전이적점39%(11/28).뇌전이류주요표현위두통、구토등로내압승고정후군화편탄、하지핍력、실어등정위증상이급전간등,로내전이류이단발병조위다견,점82%(23/28),위우막상(침협、정협、액협)자점57%(16/28),위우막하(소뇌)자점43%(12/28);전이성뇌류수술절제후중위생존시간위9.4개월,1년생존솔위28.9%,5년생존솔위7.1%.다인소분석제시로내단발병조전이(χ2=7.35,P<0.05)화무로외기타부위전이(χ2=6.47,P<0.05)시대장암뇌전이예후적독립영향인소.28례균접수수술절제화다학과협작치료,무수술사망화출혈급재수술병례.결론 대장암뇌전이총체예후흠가,수술절제뇌전이병조가연장부분환자적존활시간.
Objective Brain metastasis(BM) is unusual in colorectal carcinoma(CRC) patients.This study was to evaluate the characteristics and prognosis of brain metastasis of colorectal carcinoma patients.Methods Twenty-eight consecutive CRC patients underwent surgical resection for BM between January 2001 and December 2008.The clinical data were analyzed by univariate (logrank) and Cox regression test.Results The median age at BM diagnosis from CRC was 57 years(41-75 years).Median survival after neurosurgical intervention was 9.4 months.The 1-year and 5-year survival rates were 28.9%and 7.1%,respectively.Seventeen patients(61%)had concurrent systemic metastasis.All patients were symptomatic with neurologic deficits and symptoms.On multivariate analysis,gender,infratentorial location of lesions and characteristics of primary CRC had no significant impact on survival.Two factors were signitlcandy associated with better survival:single brain metastases and absence of extracranial metastases.Perioperative mortality was zero.There were no difference of survival among patients undergoing resection alone and resection combined with whole brain radiotherapy (WBRT) or stereotactic radiosurgery(SRS). Conclusions Brain metastases from colorectal cancer is an evil omen of poor prognosis of CRC patients.Sursical resection of symptomatic brain metastases from colorectal cancer is relatively safe and provides the opportunity for prolonged survival.