Department of Medical Oncology, Institut Curie, Paris, France.
Department of Medical Oncology, Institut Curie, Paris, France; University Paris Descartes, Paris.
Ann Oncol. 2010 Nov;21(11):2183-2187. doi: 10.1093/annonc/mdq232. Epub 2010 Apr 29.
Breast cancer is the leading nonhematologic cause of meningeal carcinomatosis (MC). The aim of this study was to report the outcome of patients diagnosed with breast cancer MC and treated in single institution by a high-dose intrathecal methotrexate (MTX) regimen.
Ninety-one patients were diagnosed with breast cancer MC from 2000 to 2007. Intrathecal treatment was MTX 15 mg/day (days 1-5), hydrocortisone acetate (day 1) and oral folinic acid (days 1-5), repeated every 2 weeks. Patients and tumor characteristics were associated with the early clinical and biological outcome and with the overall survival (OS).
The median survival was 4.5 months (range 0-53). In multivariate analysis, adverse prognostic factors at diagnosis were performance status >2 [P = 0.006, response rate (RR) = 0.33 (0.15-0.71)], more than three chemotherapy regimens before MC diagnosis [P = 0.03, RR = 0.40 (0.19-0.93)], negative hormone receptor status [P = 0.02, RR = 0.4 (0.19-0.90)] and high Cyfra 21-1 level [P = 0.048, RR = (0.09-0.99)]. Clinical progression after one cycle and biological response after two cycles were independently associated with OS [P < 0.001, RR = 0.09 (0.02-0.37) and P = 0.003, RR = 3.6 (1.5-8.5), respectively]. We propose a prognostic score in order to define three distinct groups of prognosis.
MC presents a poor prognosis, but 1-year survival rate was 25%. This score may become a useful tool for treatment decision and clinical trials.
乳腺癌是脑膜转移瘤（MC）的主要非血液学病因。本研究旨在报告在单中心接受高剂量鞘内甲氨蝶呤（MTX）方案治疗的乳腺癌脑膜转移患者的结局。
2000 年至 2007 年期间，91 例患者被诊断为乳腺癌脑膜转移。鞘内治疗方案为 MTX 15 mg/天（第 1-5 天），醋酸氢化可的松（第 1 天）和口服亚叶酸（第 1-5 天），每 2 周重复一次。患者和肿瘤特征与早期临床和生物学结局以及总生存期（OS）相关。
中位生存期为 4.5 个月（范围 0-53）。多变量分析显示，诊断时的不良预后因素包括体力状态 >2（P = 0.006，缓解率（RR）为 0.33（0.15-0.71））、MC 诊断前接受超过三种化疗方案（P = 0.03，RR 为 0.40（0.19-0.93））、激素受体状态阴性（P = 0.02，RR 为 0.4（0.19-0.90））和 Cyfra 21-1 水平高（P = 0.048，RR = 0.09-0.99）。一个周期后的临床进展和两个周期后的生物学反应与 OS 独立相关（P < 0.001，RR 分别为 0.09（0.02-0.37）和 P = 0.003，RR 为 3.6（1.5-8.5））。我们提出了一种预后评分，以定义三种不同的预后组。
MC 预后较差，但 1 年生存率为 25%。该评分可能成为治疗决策和临床试验的有用工具。
