CAJ | 학술논문

目的探讨脑膜转移癌(LM)患者的临床特点和治疗方法,并进行预后因素分析.方法回顾性分析2002年12月至2011年12月间77例LM患者的临床特征和随访资料,采用Kaplan-Meier 法绘制生存曲线,并分析影响LM患者预后的因素.结果 77例LM患者的中位生存时间为88 d,1年生存率为14.3％ (11/77).单因素分析显示,KPS评分、原发肿瘤控制情况和全身治疗情况与LM患者的生存时间有关(均P ＜0.05),全身治疗组和未全身治疗组患者的中位生存时间分别为150 d和60 d(P =0.001).全身治疗联合局部治疗(脑脊膜放疗或鞘内化疗)可进一步提高患者的生存时间.多因素分析显示,近期疗效和KPS评分是影响LM患者预后的独立因素(均P＜0.05).结论 KPS评分和近期疗效是影响LM患者的独立预后因素.全身化疗和(或)靶向治疗可提高LM患者的生存时间,建议首选全身系统治疗(包括全身化疗、靶向治疗)为基础的治疗方案,根据患者具体情况,全身治疗联合全脑放疗或鞘内注射可进一步改善患者预后.
목적 탐토뇌막전이암(LM)환자적림상특점화치료방법,병진행예후인소분석.방법 회고성분석2002년12월지2011년12월간77례LM환자적림상특정화수방자료,채용Kaplan-Meier 법회제생존곡선,병분석영향LM환자예후적인소.결과 77례LM환자적중위생존시간위88 d,1년생존솔위14.3％ (11/77).단인소분석현시,KPS평분、원발종류공제정황화전신치료정황여LM환자적생존시간유관(균P ＜0.05),전신치료조화미전신치료조환자적중위생존시간분별위150 d화60 d(P =0.001).전신치료연합국부치료(뇌척막방료혹초내화료)가진일보제고환자적생존시간.다인소분석현시,근기료효화KPS평분시영향LM환자예후적독립인소(균P＜0.05).결론 KPS평분화근기료효시영향LM환자적독립예후인소.전신화료화(혹)파향치료가제고LM환자적생존시간,건의수선전신계통치료(포괄전신화료、파향치료)위기출적치료방안,근거환자구체정황,전신치료연합전뇌방료혹초내주사가진일보개선환자예후.
Objective To investigate the clinical characteristics and prognostic factors of leptomeningeal metastases (LM) from solid tumors and to develop better treatment strategies.Methods The clinical characteristics and follow-up results of 77 cases of leptomeningeal metastases (LM) from solid tumors diagnosed and treated in our hospital from 2002 to 2011 were retrospectively analyzed.Clinical characteristics,treatment methods and overall survival were analyzed using Kaplan-Meier method and Cox regression model.Results The median survival time for all the patients was 88 days.KPS score,control of the primary tumor and systemic treatment were correlated with survival time for the patients (P ＜ 0.05 for all).The median survival time of systemic treatment was 150 d and those without systemic treatment (chemotherapy and/or targeted therapy) after LM was 60 d (P =0.001).Systemic therapy combined with local treatment (radiotherapy to the meninges or intrathecal chemotherapy) further improved the survival time of patients.Multivariate analysis showed that KPS and short-term therapeutic response for the LM were independent prognostic factors (P ＜ 0.05 for both).Conclusions KPS and short-term therapeutic response are independent prognostic factores for leptomeningeal metastases from solid tumors.Systemic chemotherapy or targeted therapy can prolong the survival time.Systemic treatment (chemotherapy and/or targeted therapy) combined with radiation therapy or intrathecal injection may further improve the clinical outcomes.