Miller K D, Weathers T, Haney L G, Timmerman R, Dickler M, Shen J, Sledge G W
Division of Hematology and Oncology, Indiana University, Indianapolis, IN 46202, USA.
Ann Oncol. 2003 Jul;14(7):1072-7. doi: 10.1093/annonc/mdg300.
As screening central nervous system (CNS) imaging is not routinely performed, the incidence and clinical relevance of occult CNS metastases in advanced breast cancer is unknown.
All patients screened for participation in one of four clinical trials were included; each of the trials excluded patients with known CNS involvement and required screening CNS imaging. A cohort of breast cancer patients with symptomatic CNS metastases was identified from the IU Cancer Center Tumor Registry for comparison.
From November 1998 to August 2001, 155 screening imaging studies were performed. Twenty-three patients (14.8%) had occult CNS metastases. HER-2 overexpression (P = 0.02) and number of metastatic sites (P = 0.03) were predictive of CNS involvement by multivariate analysis. Median survival from time of metastasis (1.78 versus 2.76 years; P <0.0001) and from screening (4.67 versus 10.4 months; P = 0.0013) was shorter in patients with than without occult CNS metastasis. Survival among patients with occult CNS metastasis was similar to patients with symptomatic CNS disease.
Patients with CNS involvement, whether occult or symptomatic, have an impaired survival. Occult CNS metastasis is relatively common, but impact on survival of treating occult CNS disease in patients with progressive systemic metastases is questionable.
由于中枢神经系统（CNS）成像筛查并非常规进行，晚期乳腺癌中隐匿性CNS转移的发生率及临床相关性尚不清楚。
纳入所有筛选参与四项临床试验之一的患者；每项试验均排除已知CNS受累的患者，并要求进行CNS成像筛查。从印第安纳大学癌症中心肿瘤登记处识别出一组有症状CNS转移的乳腺癌患者作为对照。
1998年11月至2001年8月，共进行了155次筛查成像研究。23例患者（14.8%）有隐匿性CNS转移。多因素分析显示，HER-2过表达（P = 0.02）和转移部位数量（P = 0.03）可预测CNS受累情况。有隐匿性CNS转移的患者自转移时起的中位生存期（1.78年对2.76年；P <0.0001）和自筛查时起的中位生存期（4.67个月对10.4个月；P = 0.0013）均短于无隐匿性CNS转移的患者。隐匿性CNS转移患者的生存期与有症状CNS疾病患者相似。
CNS受累的患者，无论隐匿性还是有症状的，生存期均受损。隐匿性CNS转移相对常见，但对于有进行性全身转移的患者，治疗隐匿性CNS疾病对生存期的影响尚存在疑问。
