Department of Medical Oncology, Dubai Hospital, Dubai, United Arab Emirates.
Cancer. 2010 Jul 1;116(13):3084-92. doi: 10.1002/cncr.25115.
The objective of this study was to review the outcome of women with breast cancer with known receptor status who were treated with whole brain radiotherapy for brain metastases and to determine factors that impact survival.
A total of 223 women with breast cancer and brain metastases, who received whole brain radiotherapy, were identified. All women with HER-2-positive disease had received trastuzumab. Kaplan-Meier product limit method was used to determine overall survival (OS) estimates. Cox proportional hazards models were then fitted to explore the association of OS with various patient and tumor characteristics.
Median age at brain metastases diagnosis was 50 years. Sixty-seven (30.2%) patients had hormone receptor-positive/HER-2-negative disease, 101 (45.50%) had HER-2-positive disease, and 54 (24.3%) had triple receptor-negative disease. Median OS from brain metastases was 6 months, with 1-year survival of 30% (95% confidence interval [CI], 23%-36%). Women with hormone receptor-positive/HER-2-negative, HER-2-positive, and triple-negative tumors had median survivals of 5, 9, and 5 months, respectively (P = .0069). In the multivariate model, women with HER-2-positive disease had a significantly decreased risk of death compared with women with hormone receptor-positive/HER-2-negative disease (hazard ratio, 0.63; 95%CI, 0.42-0.94; P = .02). The risk of death among women with triple-negative disease compared with hormone receptor-positive/HER-2-negative disease was not significantly different (P = .54). Lower recursive partitioning analysis class and > or = 30-gray brain radiation dose were also significantly associated with a decreased risk of death.
Breast tumor subtype has a significant prognostic role among women with breast cancer and brain metastases. In addition, in the trastuzumab era factors such as recursive partitioning analysis and adequate radiation dose continue to be important prognostic factors.
本研究旨在回顾受体状态已知的乳腺癌伴脑转移患者接受全脑放疗的治疗结果，并确定影响生存的因素。
共确定了 223 例接受全脑放疗的乳腺癌伴脑转移患者。所有 HER-2 阳性疾病患者均接受了曲妥珠单抗治疗。采用 Kaplan-Meier 乘积限法确定总生存期（OS）估计值。然后，采用 Cox 比例风险模型探讨 OS 与各种患者和肿瘤特征的相关性。
脑转移诊断时的中位年龄为 50 岁。67 例（30.2%）患者存在激素受体阳性/HER-2 阴性疾病，101 例（45.50%）患者存在 HER-2 阳性疾病，54 例（24.3%）患者存在三阴性受体疾病。脑转移后的中位 OS 为 6 个月，1 年生存率为 30%（95%置信区间[CI]，23%-36%）。激素受体阳性/HER-2 阴性、HER-2 阳性和三阴性肿瘤的女性中位生存时间分别为 5、9 和 5 个月（P =.0069）。在多变量模型中，与激素受体阳性/HER-2 阴性疾病相比，HER-2 阳性疾病患者的死亡风险显著降低（风险比，0.63；95%CI，0.42-0.94；P =.02）。与激素受体阳性/HER-2 阴性疾病相比，三阴性疾病患者的死亡风险无显著差异（P =.54）。较低的递归分区分析级别和≥30Gy 脑放射剂量也与死亡风险降低显著相关。
乳腺癌脑转移患者的肿瘤亚型具有显著的预后作用。此外，在曲妥珠单抗时代，递归分区分析和足够的放射剂量等因素仍然是重要的预后因素。
