乳腺癌脑转移全脑放疗预后及预后指数分析

目的 探讨乳腺癌脑转移患者全脑放疗(WBRT)预后以及不同预后指数差别。
方法 对2006-2010年间接受WBRT的99例乳腺癌脑转移患者进行Logrank法单因素与Cox法多因素预后分析,计算并比较RPA、GPA、BSBM、Rades、Carsten预后指数评分的敏感性和特异性。
结果 全组患者中位随访时间49个月,中位生存期为10个月。单因素分析显示年龄、脑转移时卡氏评分、是否伴有颅外转移、原发肿瘤控制情况、脑转移数目和WBRT后全身治疗与总生存相关(χ²=0.00~55.51,P=0.013~0.000),多因素分析证实卡氏评分<70和WBRT后全身治疗与总生存相关(χ²=35.26、7.21,P=0.000、0.007)。RPA、GPA、BSBM、Rades、Carsten预后指数评分对预测生存期≤3个月乳腺癌脑转移患者的敏感性和特异性分别为100%和85%、95%和62%、95%和86%、95%和84%、95%和85%。
结论 乳腺癌脑转移患者WBRT后全身治疗可改善患者总生存。对预测生存期≤3个月患者敏感性最好的为RPA指数,特异性最好的为BSBM指数。

Analysis of prognostic factors and prognostic indices in breast cancer patients with brain metastases after whole-brain radiotherapy

Objective To analyse the prognostic factors and 5 prognostic indices in breast cancer patients with brain metastases after whole-brain radiotherapy (WBRT). Methods Log-rank test (for univariate prognostic analysis) and Cox regression analysis (for multivariate prognostic analysis) were performed in 99 breast cancer patients with BM who received WBRT from January 2006 to February 2010. The sensitivities and specificities of prognostic indices, including recursive partitioning analysis (RPA), graded prognostic assessment (GPA), basic score for brain metastases (BSBM), Rades, and Carsten, were calculated and compared. Results The median follow-up was 49 months;the median survival was 10 months. The univariate analysis showed that age, Karnofsky performance score (KPS) at the diagnosis of BM, presence of extracranial metastases, primary tumor control, number of BM, and systemic treatment after WBRT were significantly correlated with overall survival (χ²=0.00—55.51, P=0.000—0.013). The multivariate analysis showed that KPS of<70 and systemic treatment after WBRT were significantly correlated with overall survival (χ²=35.26, P=0.000;χ²=7.21, P=0.007). In predicting ≤3 months of survival for breast cancer patients with BM, the sensitivities and specificities of RPA, GPA, BSBM, Rades, and Carsten were 100% and 85%, 95% and 62%, 95% and 86%, 95% and 84%, and 95% and 85%, respectively. Conclusions Systemic treatment after WBRT can improve overall survival in breast cancer patients with BM. In predicting ≤3 months of survival, RPA is the most sensitive index, and BSBM is the most specific index.