胃癌脑转移18例临床分析

目的：分析胃癌脑转移患者的临床特征及预后因素。方法回顾性分析2004年1月至2013年12月江西省肿瘤医院连续收治的18例胃腺癌脑转移患者临床资料，进行生存分析。结果患者男13例，女5例，中位年龄56岁（16～83岁）。患者诊断脑转移前均有神经症状，常见不适为头痛（38．9％）、乏力（33．3％）和恶心呕吐（22．2％）。确诊胃癌至发现脑转移的中位时间为10．4个月。同时性脑转移者5例，异性脑转移13例。44％为单一脑转移灶，56％为多发脑转移。13例（72．2％）合并颅外转移，常见部位是远处淋巴结（92．3％）、肝脏（46．2％）和骨（30．8％）。根据脑转移瘤治疗方式将患者分成3组，A组（ n＝7）给予地塞米松对症处理；B组（n＝7）地塞米松联合全脑放疗（WBRT ）；C组（n＝4）在激素的基础上，接受全脑放疗和三维适形放疗。全组患者中位生存时间2．5个月（95％ CI1．25～3．75个月），1年生存率16．7％。A、B、C3组中位总生存分别为1．9个月，2．5个月和20．7个月；A组与B组患者比较，总生存差异无统计学意义（ P＝0．46），C组患者生存获益明显（ P＝0．012）。单因素分析发现，ECOG评分0～2分（P＝0．022）、组织学分级G1～G2（P＝0．05）、异时性脑转移（P＝0．039）、其他部位转移0～1个（P＝0．005）和接受放疗（P＝0．034）的患者预后较好；多因素分析显示，ECOG评分（P＝0．012）和合并其他部位转移（P＝0．009）是胃癌脑转移患者的独立预后因素。结论胃癌脑转移预后极差，通过多学科诊治有望延长部分患者的生存时间，ECOG评分和颅外转移可能是预测胃癌患者疗效的因素。

Clinical analysis of gastric cancer complicating brain metastases in 18 cases

Objective To analyze the clinical characteristics and prognostic factors in the patients with gastric cancer (GC) complicating brain metastasis(BM) .Methods The clinical data in 18 cases of MC complicating BM in the Jiangxi Provincial Tumor Hospital from January 2004 to December 2013 were retrospectively analyzed and the survival analysis was performed .Results Male was in 13 cases and female was in 5 cases ,the median age was 56 years old(16-83 years old) .All cases had neurological symptoms before diagnosing BM ,and the common symptoms were headache (38 .9% ) ,weakness (33 .3% ) and nausea/vomiting (22 .2% ) . The median time from diagnosing GC to discovering BM was 10 .4 months .The simultaneous BM was in 5 cases and anisotropic BM was in 13 cases .Single BM accounted for 44% and multiple BM accounted for 56% .Thirteen cases (72 .2% ) of BM were compli‐cated by extracranial metastases ,the usual sites were distant lymph nodes ,liver and bone ,which accounting for 92 .3% ,46 .2% and 30 .8% respectively .The cases were divided into 3 groups according to BM tumor treatment mode .The group A(7 cases) was given the dexamethasone symptomatic treatment ;the group B(7 cases) was treated by dexamethasone combined with whole brain radio‐therapy(WBRT );the group C(4 cases) received WBRT plus three dimensional conformal radiatiotherapy on the basis of hormone . The median survival time in all cases was 2 .5 months (95% CI 1 .25-3 .75 months) and 1‐year survival rate was 16 .7% .The me‐dian total survival time in the group A ,B and C was 1 .9 ,2 .5 ,30 .7 months respectively ;compared with the group A ,the total sur‐vival in the group B had no statistical difference(P=0 .46) ,while the group C had obvious survival benefit(P=0 .012) .The univari‐ate analysis found that the patients with the ECOG score (P=0 .012) ,histological classification G1-G2(P=0 .05) ,anisotropic BM (P=0 .039) ,number of other metastasis lesions 0-1(P=0 .005) and receiving radiotherapy had better prognosis ;the multivariate analysis found that the ECOG score(P=0 .012) and complicating other site metastasis (P=0 .009) were the independent prognostic factors in the patients with GC complicating BM .Conclusion GC complicating BM has worse prognosis .The multidisciplinary diag‐nosis and treatment is expected to extend the survival in partial patients .The ECOG score and extracranial metastasis may be the factors for predicting the curative effect of GC patients .