Lee Sung Sook, Ahn Jin-Hee, Kim Min Kyoung, Sym Sun Jin, Gong Gyungyub, Ahn Seung Do, Kim Sung-Bae, Kim Woo Kun
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea.
Breast Cancer Res Treat. 2008 Oct;111(3):523-30. doi: 10.1007/s10549-007-9806-2. Epub 2007 Nov 8.
The purpose of this retrospective study was to analyze the overall survival of patients with brain metastases due to breast cancer and to identify prognostic factors that affect clinical outcome.
Of the 7,872 breast cancer patients histologically diagnosed with breast cancer between January 1990 and July 2006 at the Asan Medical Center, 198 patients with solitary or multiple brain metastases were included in this retrospective study. Central nervous system (CNS) lesions were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). Patients with leptomeningeal or dural metastases without co-existent parenchymal metastatic lesions were excluded in this study. We reviewed the medical records and pathologic data of these 198 patients to characterize the clinical features and outcomes.
The median age of the patients at the diagnosis of brain metastases was 45 years (range 26-78 years). Fifty-five patients (28%) had a single brain metastasis, whereas 143 (72%) had more than two metastases. A total of 157 (79.2%) patients received whole-brain radiation therapy (WBRT). A total of 7 (3.6%) patients underwent resection of solitary brain metastases, 22 (11%) patients underwent gamma-knife surgery, three patients underwent intrathecal chemotherapy (1.5%) and 9 (4.6%) patients received no treatment. The overall median survival time was 5.6 months (95% confidence interval (CI), 4.7-6.5 months) and 23.1% of the patients survived for more than 1 year. The median overall survival time was 5.4 months for patients treated with WBRT, 14.9 months for patients treated with surgery or gamma-knife surgery only, and 2.1 months for patients who received no treatment (P < 0.001). Multivariate analysis demonstrated that Eastern Cooperative Oncology Group (ECOG) performance status (relative risk (RR) = 0.704, 95% CI 0.482-1.028, P = 0.069), number of brain metastases (RR = 0.682, 95% CI 0.459-1.014, P = 0.058), treatment modalities (RR = 1.686, 95% CI 1.022-2.781, P = 0.041), and systemic chemotherapy after brain metastases (RR = 1.871, 95% CI 1.353-2.586, P < 0.001) were independent factors associated with survival.
Although survival of breast cancer patients with brain metastases was generally short, the performance status, number of brain metastases, treatment modalities and systemic chemotherapy after brain metastases were significantly associated with survival. Patients with single-brain metastasis and good performance status deserve aggressive treatment. The characteristics of initial primary breast lesions did not affect survival after brain metastasis.
本回顾性研究旨在分析乳腺癌脑转移患者的总生存期，并确定影响临床结局的预后因素。
在1990年1月至2006年7月于峨山医学中心经组织学诊断为乳腺癌的7872例患者中，198例有孤立性或多发性脑转移的患者被纳入本回顾性研究。中枢神经系统（CNS）病变通过计算机断层扫描（CT）或磁共振成像（MRI）诊断。本研究排除了有软脑膜或硬脑膜转移但无并存实质转移病变的患者。我们回顾了这198例患者的病历和病理数据，以描述其临床特征和结局。
脑转移诊断时患者的中位年龄为45岁（范围26 - 78岁）。55例（28%）患者有单个脑转移，而143例（72%）有两个以上转移。共有157例（79.2%）患者接受了全脑放射治疗（WBRT）。共有7例（3.6%）患者接受了孤立性脑转移瘤切除术，22例（11%）患者接受了伽玛刀手术，3例患者接受了鞘内化疗（1.5%），9例（4.6%）患者未接受治疗。总中位生存期为5.6个月（95%置信区间（CI），4.7 - 6.5个月），23.1%的患者存活超过1年。接受WBRT治疗的患者中位总生存期为5.4个月，仅接受手术或伽玛刀手术治疗的患者为14.9个月，未接受治疗的患者为2.1个月（P < 0.001）。多因素分析表明，东部肿瘤协作组（ECOG）体能状态（相对风险（RR） = 0.704，95% CI 0.482 - 1.028，P = 0.069）、脑转移灶数量（RR = 0.682，95% CI 0.459 - 1.014，P = 0.058）、治疗方式（RR = 1.686，95% CI 1.022 - 2.781，P = 0.041）以及脑转移后全身化疗（RR = 1.871，95% CI 1.353 - 2.586，P < 0.001）是与生存相关的独立因素。
尽管乳腺癌脑转移患者的生存期通常较短，但体能状态、脑转移灶数量、治疗方式以及脑转移后全身化疗与生存显著相关。单个脑转移且体能状态良好的患者值得积极治疗。初始原发性乳腺病变的特征不影响脑转移后的生存。
