Paul van Schie, Ruben G Huisman, Terry Wiersma, Joost L Knegjens, Edwin P M Jansen, Dieta Brandsma, Annette Compter, Philip C de Witt Hamer, René Post, Gerben R Borst
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引用次数: 0
Abstract
Background: Novel systemic therapies, such as immunotherapy and targeted therapies, have shown better systemic disease control in the last decennium. However, the effect of these treatments on distant brain failure (DBF) in patients with brain metastases (BM) remains a topic of discussion. Improving time to DBF leads to longer overall survival (OS), as is reflected in the brain metastasis velocity (BMV). This study presents real world data about the combined effects of local and systemic treatments on DBF and survival.
Methods: A retrospective consecutive cohort study was conducted. Patients with newly diagnosed BM were included between June 2018 and May 2020. Factors associated with DBF were analyzed in multivariate models. The association between BMV and overall survival was analyzed with linear regression analysis.
Results: Three hundred and three patients were included. Two hundred and sixty-two (86%) patients received stereotactic radiotherapy, 41 (14%) awaited in first instance the intracranial effect of newly started or switched systemic treatment. Median time to DBF after radiotherapy was 21 months (95% CI 15-27), median OS was 20 months (IQR 10-36). Receiving immunotherapy or targeted therapy were associated with a lower hazard of DBF, compared with chemotherapy. The presence of > 5 initial BM and progressive or stable extracranial disease were associated with increased DBF. BMV was significantly associated with overall survival.
Conclusions: In this retrospective cohort, patients who received immunotherapy or targeted therapy experienced a reduced risk of DBF in comparison to those treated with chemotherapy. A higher BMV was associated with a decreased OS.
背景：在过去的十年中，新的全身治疗，如免疫治疗和靶向治疗，显示出更好的全身疾病控制。然而，这些治疗对脑转移（BM）患者的远端脑衰竭（DBF）的影响仍然是一个讨论的话题。脑转移速度（BMV）反映出，改善到DBF的时间可以延长总生存期（OS）。本研究提供了关于局部和全身治疗对DBF和生存的综合影响的真实世界数据。方法：采用回顾性连续队列研究。2018年6月至2020年5月期间纳入了新诊断的BM患者。采用多变量模型分析与DBF相关的因素。采用线性回归分析BMV与总生存期的关系。结果：共纳入303例患者。262例（86%）患者接受了立体定向放疗，41例（14%）患者首次等待新开始或转换全身治疗的颅内效果。放疗后至DBF的中位时间为21个月（95% CI 15-27），中位OS为20个月（IQR 10-36）。与化疗相比，接受免疫治疗或靶向治疗与DBF的风险较低相关。bbb50初始基底膜炎和进行性或稳定性颅外疾病的存在与基底膜炎增加相关。BMV与总生存率显著相关。结论：在这个回顾性队列中，接受免疫治疗或靶向治疗的患者与接受化疗的患者相比，DBF的风险降低。较高的BMV与较低的OS相关。
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