Brain metastases are an uncommon yet life-limiting manifestation of prostate cancer. However, there is limited insight into the natural progression, therapeutics, and patient outcomes for prostate cancer once metastasized to the brain. This is a retrospective study of 461 patients with metastatic prostate cancer to the brain with a primary outcome of median overall survival (OS). The Surveillance, Epidemiology, and End Results (SEER) database was examined using Cox regression univariate and multivariable analyses, and a corresponding nomogram was developed. The median overall survival was 15 months. In the multivariable analysis, Hispanic patients had significantly increased OS (median OS 17 months,p= 0.005). Patients with tumor sizes greater than three centimeters exhibited significantly reduced OS (median OS 19 months,p= 0.014). Patients with additional metastases to the liver exhibited significantly reduced OS (median OS 3.5 months,p< 0.001). Increased survival was demonstrated in patients treated with chemotherapy or systemic treatment (median OS 19 months,p= 0.039), in addition to radiation and chemotherapy (median OS 25 months,p= 0.002). The nomogram had a C-index of 0.641. For patients with prostate metastases to the brain, median OS is influenced by race, tumor size, presence of additional metastases, and treatment. The lack of an association between traditional prostate cancer prognosis metrics, including Gleason and ISUP grading, and mortality highlights the need for individualized, metastasis-specific prognosis metrics. This prognostic nomogram for prostate metastases to the brain can be used to guide the management of affected patients.
脑转移是前列腺癌一种虽不常见但会限制生存期的表现。然而，目前对前列腺癌脑转移后的自然病程、治疗方案及患者预后仍缺乏深入了解。本研究回顾性分析了461例前列腺癌脑转移患者，主要结局指标为中位总生存期（OS）。通过使用Cox回归单变量和多变量分析对监测、流行病学和最终结果（SEER）数据库进行数据挖掘，并构建了相应的列线图预测模型。患者中位总生存期为15个月。多变量分析显示，西班牙裔患者总生存期显著延长（中位OS 17个月，p=0.005）；肿瘤直径大于三厘米的患者总生存期显著缩短（中位OS 19个月，p=0.014）；合并肝转移的患者总生存期显著降低（中位OS 3.5个月，p<0.001）。接受化疗或全身治疗（中位OS 19个月，p=0.039）以及联合放疗与化疗（中位OS 25个月，p=0.002）的患者生存期显著延长。列线图的C指数为0.641。对于前列腺癌脑转移患者，中位总生存期受种族、肿瘤大小、是否合并其他部位转移及治疗方案的影响。传统前列腺癌预后指标（包括格里森评分和ISUP分级）与死亡率缺乏关联性，这凸显了建立个体化、转移灶特异性预后评估体系的必要性。本研究所构建的前列腺癌脑转移预后列线图可用于指导临床患者的治疗决策。
肿瘤(癌症)患者之家