Slimane K, Andre F, Delaloge S, Dunant A, Perez A, Grenier J, Massard C, Spielmann M
Breast Cancer Unit, Departments of Medicine and Biostatistics, Institut Gustave-Roussy, Villejuif, France.
Ann Oncol. 2004 Nov;15(11):1640-4. doi: 10.1093/annonc/mdh432.
The occurrence of brain metastases is an emerging problem in patients with metastatic breast cancer. In the present study, we looked at risk factors for brain metastasis among patients with metastatic breast cancer.
The risk factors for brain metastasis were first determined in a series of 215 patients with metastatic breast cancer. Risk factors identified in the multivariate analysis were re-evaluated in a confirmatory series of 199 patients with metastatic breast cancer. All the patients had been included in prospective randomized trials that evaluated chemotherapy or endocrine therapy in an adjuvant setting.
In the first series, the presence of lung metastases (hazard ratio = 4.3, 95% CI: 1.9-9.3, P=0.0003) and negative hormone receptor status (hazard ratio = 4.2, 95% CI: 1.7-11, P=0.002) were the only predictive factors associated with the occurrence of brain metastases in the multivariate analysis. The second series confirmed that the presence of lung metastases and negative hormone receptor status were associated with the occurrence of brain metastases.
The presence of lung metastases as the first site of relapse and a negative hormone receptor status are predictive for the occurrence of brain metastases in patients with metastatic breast cancer. A prophylactic treatment should be evaluated in these subsets of patients.
脑转移的发生是转移性乳腺癌患者中一个新出现的问题。在本研究中，我们探讨了转移性乳腺癌患者发生脑转移的危险因素。
首先在215例转移性乳腺癌患者中确定脑转移的危险因素。在199例转移性乳腺癌患者的验证队列中对多变量分析中确定的危险因素进行重新评估。所有患者均纳入了评估辅助治疗中化疗或内分泌治疗的前瞻性随机试验。
在第一个队列中，多变量分析显示肺转移的存在（风险比=4.3，95%可信区间：1.9-9.3，P=0.0003）和激素受体阴性状态（风险比=4.2，95%可信区间：1.7-11，P=0.002）是与脑转移发生相关的仅有的预测因素。第二个队列证实肺转移的存在和激素受体阴性状态与脑转移的发生相关。
作为首次复发部位的肺转移的存在以及激素受体阴性状态可预测转移性乳腺癌患者发生脑转移。应对这些亚组患者评估预防性治疗。
