CAJ | 학술논문

目的探讨乳腺癌脑转移行立体定向放疗(SRT)的预后影响因素.方法回顾分析37例行SRT的乳腺癌脑转移患者,其中首程行单纯SRT 19例,首程行全脑放疗(WBRT)加SRT 8例(WBRT与SRT间隔时间＜2个月),WBRT失败后行SRT挽救患者10例.Kaplan-Meier法计算生存期,Logrank法单因素预后分析,Cox模型多因素预后分析.结果全组患者中位随访时间11个月,仍生存患者中位随访时间15个月.全组中位生存期11个月(95％ CI=6～ 16个月).单因素预后分析显示三阴性乳腺癌(x2=5.95,P=0.004)、卡氏评分低(x2=13.85,P=0.000)、原发灶诊断至脑转移间隔时间≤30个月(x2=6.62,P=0.010)、RPA分级差(x2=15.35,P=0.000)及WBRT后复发(x2 =4.43,P=0.035)是SRT预后不良因素,多因素预后分析显示三阴性乳腺癌(x2=9.58,P=0.008)、卡氏评分低(x2=6.65,P=0.010)及WBRT后复发(x2=3.95,P=0.047)是SRT预后不良因素.结论三阴性乳腺癌、卡氏评分低及WBRT后复发是乳腺癌脑转移后行SRT的预后不良因素.
목적 탐토유선암뇌전이행입체정향방료(SRT)적예후영향인소.방법 회고분석37례행SRT적유선암뇌전이환자,기중수정행단순SRT 19례,수정행전뇌방료(WBRT)가SRT 8례(WBRT여SRT간격시간＜2개월),WBRT실패후행SRT만구환자10례.Kaplan-Meier법계산생존기,Logrank법단인소예후분석,Cox모형다인소예후분석.결과 전조환자중위수방시간11개월,잉생존환자중위수방시간15개월.전조중위생존기11개월(95％ CI=6～ 16개월).단인소예후분석현시삼음성유선암(x2=5.95,P=0.004)、잡씨평분저(x2=13.85,P=0.000)、원발조진단지뇌전이간격시간≤30개월(x2=6.62,P=0.010)、RPA분급차(x2=15.35,P=0.000)급WBRT후복발(x2 =4.43,P=0.035)시SRT예후불량인소,다인소예후분석현시삼음성유선암(x2=9.58,P=0.008)、잡씨평분저(x2=6.65,P=0.010)급WBRT후복발(x2=3.95,P=0.047)시SRT예후불량인소.결론 삼음성유선암、잡씨평분저급WBRT후복발시유선암뇌전이후행SRT적예후불량인소.
Objective To explore the prognostic factors of brain metastases from primary breast cancer treated with stereotactic radiotherapy (SRT).Methods Retrospectively analyze 37 brain metastatic patients from primary breast cancer.Among these patients nineteen were treated with stereotactic radiotherapy alone,eight patients were treated with whole brain radiotherapy (WBRT) plus SRT,the other ten patients were intracranial recurrence after WBRT and treated with SRT for salvage.Kaplan-Meier analyses were used to calculate survival time.Logrank and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses.Results The median follow-up time were 11 months and 15 months for the whole group and the alive.The median overall survival time was 11 months (95％ CI =6-16.month) for the whole group.The median overall survival time was 13.5 months for the whole group.In univariate analysis,the triple negative breast cancer (x2 =5.95,P =0.004),lower Karnofsky performance score (KPS,x2 =13.85,P =0.000),the interval between the diagnosis of the primary tumor and brain metastases ≤ 30 months (x2 =6.62,P =0.010),high RPA grade (x2 =15.35,P =0.000) and intracranial recurrence after whole brain radiotherapy (x2 =4.43,P =0.035) were negative prognostic factors for brain metastasis of breast cancer treated with stereotactic radiotherapy.In multivariate analyses,the triple negative breast cancer (x2 =9.58,P =0.008),lower KPS (x2 =6.65,P =0.010),and intracranial recurrence after whole brain radiotherapy (x2 =3.95,P =0.047) were negative prognostic factor.Conclusion The triple negative breast cancer,lower KPS,and intracranial recurrence after WBRT were negative prognostic factor for brain metastasis from primary breast cancer treated with SRT.