手术在复发性局部脑转移中的作用:一项多机构回顾性分析。

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Stefano Telera, Luigino Tosatto, Roberto Colasanti, Andrea Pace, Veronica Villani, Fabrizio Rasile, Mario Lecce, Francesco Crispo, Laura Marucci, Alessia Farneti, Mariantonia Carosi, Mariangela Novello, Francesca Romana Giordano, Isabella Sperduti, Roberto Gazzeri
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引用次数: 0

摘要

背景:局部复发性脑转移瘤是指在之前接受过局部治疗后,在脑部同一部位复发的病灶。对于已经接受过手术治疗的患者,由于疤痕形成、脑血管或脑区浸润以及之前放疗的局部影响,第二次手术可能具有潜在的挑战性。本研究旨在回顾性分析一系列局部复发病灶二次手术治疗的结果和并发症,并对相关文献进行综述。方法:回顾性分析了2000年至2022年期间因组织学确诊的局部复发性脑转移瘤而接受手术治疗的37例患者的以下参数:年龄、组织学、解剖位置、复发时间、既往放疗情况、复发肿瘤的大小、术前和术后卡诺夫斯基表现状态(KPS)评分、复发分区分析(RPA)等级和分级预后评估(GPA)评分、手术相关并发症以及是否存在进一步的脑转移瘤。总生存期(OS)采用卡普兰-梅耶法计算。使用逐步回归法(前向选择)建立了一个多变量考克斯比例危险模型,其中包含在单变量分析中具有显著意义的预测变量:结果:第二次手术后,术后 KPS 状态明显改善。在多变量分析中,术前KPS≥70的患者和首次手术后接受过放疗的患者的OS结果更好。没有观察到与之前治疗相关的明显术后并发症:对局部复发性脑转移瘤进行手术切除可改善患者的神经系统状况,使全身治疗有更多时间发挥作用,且手术相关发病率和死亡率较低。然而,要想获得最佳的术后效果,似乎必须谨慎选择术前临床状况良好的患者,因为由于患者群的高度异质性,目前还无法建立统一的治疗范式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The role of surgery in recurrent local cerebral metastases: a multi-institutional retrospective analysis.

Background: Local recurrent brain metastases are defined as lesions that recur in the brain at the same site after a previous local therapy. In patients already submitted to surgery, a second operation may be potentially challenging due to scar formation, infiltration of cerebral vessels or eloquent brain areas and local effect of previous radiotherapy. The aim of this study is to retrospectively review the results and complications of a second surgical treatment in a series of local recurrent lesions and to review the literature on this topic.

Methods: 37 patients submitted to surgery for a local, histologically confirmed, recurrent brain metastases between 2000 and 2022 were retrospectively analyzed with respect to the following parameters: age, histology, anatomic location, time to recurrence, previous radiotherapy, size of recurrent tumors, preoperative and postoperative Karnofsky Performance Status (KPS) score, recursive partitioning analysis (RPA) class and graded prognostic assessment (GPA) score, surgery-related complications and the presence of further cerebral metastases. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariate Cox proportional hazard model was developed using stepwise regression (forwards selection) with predictive variables that were significant in the univariate analyses.

Results: A significant improvement of post-operative KPS status was obtained after second surgery. At multivariate analysis better results in terms of OS were achieved in patients with a pre-operative KPS ≥ 70 and in patients who had received radiotherapy after the initial surgery. No significant postoperative complications related to previous treatments were observed.

Conclusions: Surgical resection of local recurrent brain metastases may improve patients ́ neurologic conditions allowing more time for systemic therapies to act with a low incidence of surgery-related morbidity and mortality. However, careful patient selection with a fair pre-operative clinical status seems mandatory to achieve the best post-operative results, since uniform treatment-paradigms cannot be established yet, due to the highly heterogeneous patient cohort.

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来源期刊
Neurosurgical Review
Neurosurgical Review 医学-临床神经学
CiteScore
5.60
自引率
7.10%
发文量
191
审稿时长
6-12 weeks
期刊介绍: The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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