Nam Byung-Ho, Kim Sun Young, Han Hye-Sook, Kwon Youngmee, Lee Keun Seok, Kim Tae Hyun, Ro Jungsil
Center for Clinical Trials, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
Breast Cancer Res. 2008;10(1):R20. doi: 10.1186/bcr1870. Epub 2008 Feb 28.
Brain metastases (BM) occur in up to one third of patients with metastatic breast cancer (MBC), whose incidences and prognoses by breast cancer subtypes in BM have not been well delineated.
Retrospective survival analyses were performed in 126 BM patients from 805 MBC patients treated at the National Cancer Center between August 2001 and April 2006, according to clinical characteristics, breast cancer subtypes, and receipt of trastuzumab. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor-2 (HER2) statuses were tested by immunohistochemical (IHC) staining, and HER2 FISH analysis conducted for IHC 2+.
The proportion of HER2+/ER- (29% vs 16%) and triple-negative (37% vs 25%) tumors was higher in the 126 BM patients than those without BM. While median survival after recurrence was longer in patients with luminal A disease (median survival of luminal A vs luminal B vs HER2+/ER- vs triple-negative: p = 0.0246; 39.6 vs 27.4 vs 20.9 vs 15.5 months), survival was shorter from BM to death in luminal A and triple negatives (median survival: p = 0.0113; 4.0 vs 9.2 vs 5.0 vs 3.4 months). Receipt of trastuzumab after BM was a significant variable for survival in HER2+ patients. Multivariate analyses identified ER-negative, HER2-negative, or triple-negative, as well as older age, presence of leptomeningeal disease, and three or more extracranial disease sites, as poor prognostic factors for survival after BM.
MBC patients who developed BM had higher proportions of triple-negative and HER2+/ER- tumor status. Triple receptor status is a useful prognostic marker for predicting survival after BM in metastatic breast cancer patients.
脑转移（BM）发生在多达三分之一的转移性乳腺癌（MBC）患者中，BM中乳腺癌亚型的发病率和预后尚未得到很好的描述。
对2001年8月至2006年4月在国家癌症中心接受治疗的805例MBC患者中的126例BM患者进行回顾性生存分析，根据临床特征、乳腺癌亚型和曲妥珠单抗的使用情况进行分析。通过免疫组织化学（IHC）染色检测雌激素受体（ER）、孕激素受体（PR）和人表皮生长受体2（HER2）状态，并对IHC 2+进行HER2荧光原位杂交（FISH）分析。
126例BM患者中HER2+/ER-（29%对16%）和三阴性（37%对25%）肿瘤的比例高于无BM的患者。虽然腔面A型疾病患者复发后的中位生存期较长（腔面A与腔面B与HER2+/ER-与三阴性的中位生存期：p = 0.0246；39.6对27.4对20.9对15.5个月），但腔面A型和三阴性患者从BM到死亡的生存期较短（中位生存期：p = 0.0113；4.0对9.2对5.0对3.4个月）。BM后使用曲妥珠单抗是HER2+患者生存的一个重要变量。多变量分析确定ER阴性、HER2阴性或三阴性，以及年龄较大、软脑膜疾病的存在和三个或更多颅外疾病部位是BM后生存的不良预后因素。
发生BM的MBC患者中三阴性和HER2+/ER-肿瘤状态的比例较高。三受体状态是预测转移性乳腺癌患者BM后生存的有用预后标志物。
