Souglakos John, Vamvakas Lambros, Apostolaki Stella, Perraki Maria, Saridaki Zacharenia, Kazakou Irine, Pallis Athanasios, Kouroussis Charalambos, Androulakis Nikos, Kalbakis Kostas, Millaki Georgia, Mavroudis Dimitris, Georgoulias Vassilis
Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece.
Breast Cancer Res. 2006;8(4):R36. doi: 10.1186/bcr1516.
To evaluate the incidence of central nervous system (CNS) involvement in patients with breast cancer treated with a taxane-based chemotherapy regimen and to determine predictive factors for CNS relapse.
The medical files of patients with early breast cancer (n = 253) or advanced stage breast cancer (n = 239) as well of those with other solid tumors (n = 336) treated with or without a taxane-based chemotherapy regimen during a 42-month period were reviewed. HER2/neu overexpression was identified by immunohistochemistry, whereas cytokeratin 19 (CK-19) mRNA-positive circulating tumor cells (CTCs) in the peripheral blood were identified by real-time PCR.
The incidence of CNS relapse was similar in patients suffering from breast cancer or other solid tumors (10.4% and 11.4%, respectively; P = 0.517). The incidence of CNS relapse was significantly higher in breast cancer patients with advanced disease (P = 0.041), visceral disease and bone disease (P = 0.036), in those who were treated with a taxane-containing regimen (P = 0.024), in those with HER2/neu-overexpressing tumors (P = 0.022) and, finally, in those with detectable CK-19 mRNA-positive CTCs (P = 0.008). Multivariate analysis revealed that the stage of disease (odds ratio, 0.23; 95% confidence interval, 0.007-0.23; P = 0.0001), the HER2/neu status (odds ratio, 29.4; 95% confidence interval, 7.51-101.21; P = 0.0001) and the presence of CK-19 mRNA-positive CTCs (odds ratio, 8.31; 95% confidence interval, 3.97-12.84; P = 0.001) were independent predictive factors for CNS relapse.
CNS relapses are common among breast cancer patients treated with a taxane-based chemotherapy regimen, patients with HER2/neu-positive tumor and patients with CK-19 mRNA-positive CTCs.
评估接受紫杉类化疗方案治疗的乳腺癌患者中枢神经系统（CNS）受累的发生率，并确定CNS复发的预测因素。
回顾了42个月期间接受或未接受紫杉类化疗方案治疗的早期乳腺癌患者（n = 253）、晚期乳腺癌患者（n = 239）以及其他实体瘤患者（n = 336）的病历。通过免疫组织化学鉴定HER2/neu过表达，而通过实时PCR鉴定外周血中细胞角蛋白19（CK-19）mRNA阳性循环肿瘤细胞（CTC）。
乳腺癌患者和其他实体瘤患者的CNS复发发生率相似（分别为10.4%和11.4%；P = 0.517）。晚期疾病（P = 0.041）、内脏疾病和骨疾病（P = 0.036）的乳腺癌患者、接受含紫杉类方案治疗的患者（P = 0.024）、HER2/neu过表达肿瘤患者（P = 0.022）以及最后可检测到CK-19 mRNA阳性CTC的患者（P = 0.008）的CNS复发发生率显著更高。多因素分析显示，疾病分期（比值比，0.23；95%置信区间，0.007 - 0.23；P = 0.0001）、HER2/neu状态（比值比，29.4；95%置信区间，7.51 - 101.21；P = 0.0001）和CK-19 mRNA阳性CTC的存在（比值比，8.31；95%置信区间，3.97 - 12.84；P = 0.001）是CNS复发的独立预测因素。
在接受紫杉类化疗方案治疗的乳腺癌患者、HER2/neu阳性肿瘤患者和CK-19 mRNA阳性CTC患者中，CNS复发很常见。
