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Abstract：
BACKGROUND: Stereotactic irradiation has become the mainstay treatment for brain metastases (BM), and whole-brain radiotherapy (WBRT) is often used for symptom palliation. However, the survival time of patients with BM undergoing palliative WBRT (pWBRT) is limited, making it difficult to select patients who should receive treatment.
METHODS: We collected patient data from 2016 to 2022 at the Shizuoka Cancer Center and retrospectively analyzed the factors related to survival time. Overall survival (OS) was defined as the survival time after WBRT.
RESULTS: A total of 301 patients (median age, 66 years) who underwent pWBRT were included. The primary cancers were lung, breast, gastrointestinal tract, and other cancers in 203 (67%), 38 (13%), 33 (11%), and 27 (9%) patients, respectively. Median OS of all patients was 4.1 months. In the multivariate analysis, male sex (hazard ratio [HR]:1.4), Karnofsky Performance Status (KPS) ≤ 60 (HR:1.7), presence of extracranial metastasis (ECM) (HR:1.6), neutrophil-lymphocyte ratio (NLR) ≥ 5 (HR:1.6), and lactate dehydrogenase (LDH) ≥ upper limit of normal (ULN) (HR:1.3) were significantly associated with shorter OS (all P < 0.05). To predict the OS, we created a prognostic scoring system (PSS). We gave one point to each independent prognostic factor. Median OS for patients with scores of 0-2, 3, and 4-5 were 9.0, 3.5 and 1.7 months, respectively (P < 0.001).
CONCLUSIONS: Male sex, KPS ≤ 60, presence of ECM, NLR ≥ 5, and LDH ≥ ULN were poor prognostic factors for patients with BM undergoing pWBRT. By PSS combining these factors, it may be possible to select patients who should undergo pWBRT.
METHODS: We collected patient data from 2016 to 2022 at the Shizuoka Cancer Center and retrospectively analyzed the factors related to survival time. Overall survival (OS) was defined as the survival time after WBRT.
RESULTS: A total of 301 patients (median age, 66 years) who underwent pWBRT were included. The primary cancers were lung, breast, gastrointestinal tract, and other cancers in 203 (67%), 38 (13%), 33 (11%), and 27 (9%) patients, respectively. Median OS of all patients was 4.1 months. In the multivariate analysis, male sex (hazard ratio [HR]:1.4), Karnofsky Performance Status (KPS) ≤ 60 (HR:1.7), presence of extracranial metastasis (ECM) (HR:1.6), neutrophil-lymphocyte ratio (NLR) ≥ 5 (HR:1.6), and lactate dehydrogenase (LDH) ≥ upper limit of normal (ULN) (HR:1.3) were significantly associated with shorter OS (all P < 0.05). To predict the OS, we created a prognostic scoring system (PSS). We gave one point to each independent prognostic factor. Median OS for patients with scores of 0-2, 3, and 4-5 were 9.0, 3.5 and 1.7 months, respectively (P < 0.001).
CONCLUSIONS: Male sex, KPS ≤ 60, presence of ECM, NLR ≥ 5, and LDH ≥ ULN were poor prognostic factors for patients with BM undergoing pWBRT. By PSS combining these factors, it may be possible to select patients who should undergo pWBRT.
摘要：
背景：立体定向照射已成为脑转移瘤（BM）的主要治疗方法，全脑放疗（WBRT）通常用于缓解症状。然而,接受姑息性WBRT（pWBRT）的BM患者的生存时间有限，很难选择应该接受治疗的患者。
方法：我们收集了静冈癌症中心2016年至2022年的患者数据，并回顾性分析了与生存时间相关的因素。总生存期（OS）定义为WBRT后的生存时间。
结果：共有301名患者（中位年龄，66岁)接受pWBRT的患者被包括在内。原发性癌症是肺癌，乳房,胃肠道,和其他癌症在203（67%），38（13%），33（11%），27名（9%）患者，分别。所有患者的中位OS为4.1个月。在多变量分析中，男性（危险比[HR]：1.4），Karnofsky性能状态（KPS）≤60（HR：1.7），存在颅外转移（ECM）（HR：1.6），中性粒细胞-淋巴细胞比值（NLR）≥5（HR：1.6），乳酸脱氢酶(LDH)≥正常上限(ULN)(HR:1.3)与OS缩短显著相关(均P<0.05)。为了预测操作系统，我们创建了一个预后评分系统（PSS）。我们对每个独立的预后因素给予一点。0~2、3、4~5分患者的中位OS分别为9.0、3.5和1.7个月,分别(P<0.001)。
结论：男性，KPS≤60，存在ECM，NLR≥5和LDH≥ULN是接受pWBRT的BM患者的不良预后因素。通过PSS结合这些因素，有可能选择应该接受pWBRT的患者.
方法：我们收集了静冈癌症中心2016年至2022年的患者数据，并回顾性分析了与生存时间相关的因素。总生存期（OS）定义为WBRT后的生存时间。
结果：共有301名患者（中位年龄，66岁)接受pWBRT的患者被包括在内。原发性癌症是肺癌，乳房,胃肠道,和其他癌症在203（67%），38（13%），33（11%），27名（9%）患者，分别。所有患者的中位OS为4.1个月。在多变量分析中，男性（危险比[HR]：1.4），Karnofsky性能状态（KPS）≤60（HR：1.7），存在颅外转移（ECM）（HR：1.6），中性粒细胞-淋巴细胞比值（NLR）≥5（HR：1.6），乳酸脱氢酶(LDH)≥正常上限(ULN)(HR:1.3)与OS缩短显著相关(均P<0.05)。为了预测操作系统，我们创建了一个预后评分系统（PSS）。我们对每个独立的预后因素给予一点。0~2、3、4~5分患者的中位OS分别为9.0、3.5和1.7个月,分别(P<0.001)。
结论：男性，KPS≤60，存在ECM，NLR≥5和LDH≥ULN是接受pWBRT的BM患者的不良预后因素。通过PSS结合这些因素，有可能选择应该接受pWBRT的患者.
