鞘内化疗在治疗乳腺癌脑膜癌变中的作用。

IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL
Einstein-Sao Paulo Pub Date : 2023-12-22 eCollection Date: 2023-01-01 DOI:10.31744/einstein_journal/2023AO0481
Renata Tortato Meneguetti, Felipe José Silva Melo Cruz, Auro Del Giglio
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引用次数: 0

摘要

目的:评估脑膜内化疗是否能改善脑膜癌患者的临床疗效:评估鞘内化疗是否能改善脑膜癌肿患者的临床预后:这项回顾性队列研究包括连续确诊为脑膜癌肿的乳腺癌患者。临床和治疗数据来自患者的病历。主要结果是总生存期,次要结果是神经功能恶化时间和临床获益报告。在评估临床反应和总生存期时,分别采用了调整潜在混杂因素后的逻辑回归和考克斯比例危险模型:共纳入109名女性患者,其中50人(45.9%)接受了甲氨蝶呤和地塞米松的鞘内化疗。中位治疗时间为3周(1-13周不等)。接受鞘内化疗的患者更有可能报告临床获益(74%对57.7%,调整后的几率比[OR]=9.0,95%CI=2.6-30.9,p结论:鞘内化疗并未提高总生存率或延长神经系统恶化的时间,因此不应排除或推迟全身治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of intrathecal chemotherapy in the management of meningeal carcinomatosis in patients with breast cancer.

Objective: To evaluate whether intrathecal chemotherapy improves clinical outcomes in patients with meningeal carcinomatosis.

Methods: This retrospective cohort study included consecutive patients with breast cancer diagnosed with meningeal carcinomatosis. Clinical and treatment data were collected from the patients' medical charts. The primary outcome was overall survival, and the secondary outcomes were time to neurological deterioration and reporting of clinical benefit. Logistic regression and Cox proportional hazard models adjusted for potential confounders were used to evaluate the clinical response and overall survival, respectively.

Results: Overall, 109 female patients were included, 50 (45.9%) of whom received intrathecal chemotherapy with methotrexate and dexamethasone. The median treatment duration was 3 weeks (range, 1-13 weeks). Patients treated with intrathecal chemotherapy were more likely to report clinical benefit (74% versus 57.7%, adjusted odds ratio [OR] = 9.0, 95%CI=2.6-30.9, p<0.001). However, there was no difference in the time to neurologic deterioration (hazard ratio [HR] = 0.96, 95%CI= 0.57-1.59, p=0.86). Patients who received intrathecal chemotherapy did not show an increase in overall survival compared with that of patients who did not receive intrathecal chemotherapy (median overall survival = 1.8 months, 95%CI= 1.27-3.0 versus 2.5, 95%CI= 1.9-3.9, adjusted HR = 0.71, 95%CI= 0.41-1.22, p=0.21). There was a significant interaction between intrathecal chemotherapy and systemic treatment, and patients who received systemic therapy without intrathecal chemotherapy had better overall survival than that of the no-treatment group (adjusted HR = 0.38, 95%CI= 0.20-0.70, p=0.002).

Conclusion: Intrathecal chemotherapy did not increase overall survival or time to neurological deterioration and should not preclude or postpone systemic treatments.

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来源期刊
Einstein-Sao Paulo
Einstein-Sao Paulo MEDICINE, GENERAL & INTERNAL-
CiteScore
2.00
自引率
0.00%
发文量
210
审稿时长
38 weeks
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