Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7305, USA.
Cancer. 2011 Apr 15;117(8):1602-11. doi: 10.1002/cncr.25746. Epub 2010 Nov 29.
Brain metastases (BM) arising from triple-negative breast cancer (TNBC) portend a poor prognosis. TNBC is more common in premenopausal and African-American (AA) patients; both of these characteristics also confer a poor prognosis. In a single-institution cohort study, the authors attempted to determine whether the inferior outcome noted with TNBC brain metastases is more reflective of a higher risk population or the subtype itself.
The University of North Carolina Breast Cancer Database identified patients with BC brain metastases who were diagnosed between 1988 and 2008. BC subtype was assigned by immunohistochemistry: hormone receptor (HR) positive (+);(HR, estrogen receptor [ER]+ and/or progesterone receptor [PR]+)/human epidermal growth factor receptor 2 (HER2) negative (-), HR+/HER2+, HR-/HER2+, and TN (ER-/PR-/HER2-). Survival and disease recurrence patterns were evaluated by subtype, patient age (<40 years vs ≥40 years), and race (AA vs non-AA) using the Kaplan-Meier method and Cox regression analysis.
Among 119 patients with BC brain metastases, 33% were AA and 31% were aged <40 years. BC subtype was confirmed in 98 patients (30% with HR+/HER2-, 21% with HR+/HER2+, 18% with HR-/HER2+, and 31% with TNBC). Survival after BM was found to be impacted by subtype (P = .002), and was shortest for patients with TNBC (0.24 years; 95% confidence interval, 0.17 years-0.48 years). There were no age-specific (P = .84) or race-specific (P = .09) differences in survival noted after brain metastases; stratification of BC subtypes by age and race revealed no difference (all, P > .1). The receipt of systemic therapy after BC brain metastases was found to be an important predictor of survival after BC brain metastases (hazard ratio, 0.29; P = .002) when adjusted for race, age, number of central nervous system lesions, and BC subtype.
TNBC confers a high risk of death after brain metastases regardless of patient race and age, supporting the need for novel agents capable of controlling both intracranial and extracranial TNBC across all races and ages.
三阴性乳腺癌（TNBC）引起的脑转移预示着预后不良。TNBC 在绝经前和非裔美国人（AA）患者中更为常见；这两个特征也预示着预后不良。在一项单中心队列研究中，作者试图确定 TNBC 脑转移中观察到的较差结果是否更多地反映了高危人群还是亚型本身。
北卡罗来纳大学乳腺癌数据库确定了 1988 年至 2008 年间诊断为 BC 脑转移的患者。BC 亚型通过免疫组化确定：激素受体（HR）阳性（+）；（HR、雌激素受体 [ER]+和/或孕激素受体 [PR]+）/人表皮生长因子受体 2（HER2）阴性（-），HR+/HER2+、HR-/HER2+和 TN（ER-/PR-/HER2-）。通过 Kaplan-Meier 方法和 Cox 回归分析，根据亚型、患者年龄（<40 岁与≥40 岁）和种族（AA 与非 AA）评估生存和疾病复发模式。
在 119 例 BC 脑转移患者中，33%为 AA，31%年龄<40 岁。在 98 例患者中证实了 BC 亚型（30%为 HR+/HER2-，21%为 HR+/HER2+，18%为 HR-/HER2+，31%为 TNBC）。BM 后的生存情况受亚型影响（P=0.002），TNBC 患者的生存时间最短（0.24 年；95%置信区间，0.17-0.48 年）。BM 后未观察到年龄特异性（P=0.84）或种族特异性（P=0.09）的生存差异；按年龄和种族分层的 BC 亚型无差异（均，P>.1）。在调整种族、年龄、中枢神经系统病变数量和 BC 亚型后，BC 脑转移后接受全身治疗被发现是 BC 脑转移后生存的重要预测因素（风险比，0.29；P=0.002）。
无论患者的种族和年龄如何，TNBC 都会导致脑转移后的死亡风险增加，这支持需要有新的药物来控制所有种族和年龄的颅内和颅外 TNBC。
