影响大脑转移的老年患者手术切除结果的预后因素
Yu Chang1, Heng-Juei Hsu2, Chia-En Wong1,3
1Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
The Kaohsiung journal of medical sciences
|August 26, 2025
概括
对于脑转移的老年癌症患者,男性性别,并发症和瘤位置等因素会影响存活率. 系统性治疗和良好的营养状况 (PNI) 改善了结果,指导了个性化手术决策.
科学领域:
- 癌症学
- 神经外科
- 老年病学
背景情况:
- 大脑转移 (BM) 在老年癌症患者中正在增加.
- 由于并发症,老年患者的治疗决策是复杂的.
- 确定预后因素对于优化手术切除决定至关重要.
研究的目的:
- 在老年患者中确定手术切除的预后因素.
- 帮助这些患者做出明智的治疗决策.
主要方法:
- 对124名经过手术的老年患者 (≥65岁) 进行了回顾性研究.
- 进行了生存分析和考克斯回归分析,以确定生存的独立预测因素.
- 分析的因素包括性别,脑外转移 (ECM),脑膜位置,卡诺夫斯基性能状态 (KPS),修改的脆弱指数 (mFI-5),全身治疗,全身免疫炎症指数 (SII) 和预后营养指数 (PNI).
主要成果:
- 较低的存活率与男性性别,ECM,雄辩位置的BM,KPS恶化和mFI-5≥2有关.
- 在BM诊断后的全身治疗显著改善了整体存活率 (HR: 0. 45).
- 较高的SII (HR: 1.99) 与较低的存活率相关,而较高的PNI (HR: 0.56) 表示更好的存活率.
结论:
- 对于患有骨髓瘤的老年患者来说,个性化的治疗方法是必不可少的,考虑到骨髓瘤的位置,ECM,并发症和适合全身治疗.
- 手术前的营养和炎症状态 (PNI,SII) 和性能状态 (KPS) 是重要的预后指标.
- 在手术前和手术后监测这些因素可以帮助指导治疗策略并改善患者的治疗结果.
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