Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong Gangnam-gu, 135-710 Seoul, Korea.
Breast Cancer Res Treat. 2011 Oct;129(3):809-17. doi: 10.1007/s10549-011-1682-0. Epub 2011 Jul 23.
Leptomeningeal metastasis (LM) usually occurs late during the course of breast cancer. The aim of this study was to characterize the clinical features and outcomes of LM based on breast cancer subtypes in conjunction with brain parenchymal metastases. A retrospective study was performed of breast cancer patients with LM, who received palliative management at Samsung Medical Center between 1995 and 2008. Among the 272 metastatic breast cancer patients with central nervous system (CNS) involvement, 68 patients with LM were identified. The median age was 46 years (range, 24-72 years). The median survival duration from LM to death (LM-OS) was 4.5 months (range, 0.2-26.4 months). Patients surviving for 12 or more months were rarer among triple negative (TN) patients compared to other subtypes (21.7% for HR + ve vs. 27.8% for HER2 + ve vs. 72.7% for TN, P = 0.217). Death caused by CNS involvement appeared to be much more common in TN than in other subtypes (0% for HR + ve vs. 36% for HER2 + ve vs. 64% for TN, P = 0.060). Median survival time from distant metastasis was significantly different among the three groups (28.3 vs. 29.1 vs. 11.8 months, P < 0.0001). However, median survival time from LM did not differ (4.1 vs. 5.9 vs. 3.8 months, P = 0.226). Characteristic manifestations and treatment outcomes of LM may be affected by the unique biology of breast cancer intrinsic subtypes. The different roles of active combined treatment modalities including both systemic chemotherapy and local treatment modalities should be considered to improve outcomes.
脑膜转移（LM）通常在乳腺癌病程晚期发生。本研究旨在结合脑实质转移，根据乳腺癌亚型分析 LM 的临床特征和预后。本研究回顾性分析了 1995 年至 2008 年期间在三星医疗中心接受姑息治疗的伴有 LM 的乳腺癌患者。在 272 例伴有中枢神经系统（CNS）转移的转移性乳腺癌患者中，发现 68 例伴有 LM。患者中位年龄为 46 岁（范围，24-72 岁）。从 LM 到死亡的中位生存时间（LM-OS）为 4.5 个月（范围，0.2-26.4 个月）。与其他亚型相比，三阴性（TN）患者中生存 12 个月以上的患者更为罕见（HR + ve 为 21.7%，HER2 + ve 为 27.8%，TN 为 72.7%，P = 0.217）。TN 患者 CNS 受累导致的死亡似乎比其他亚型更为常见（HR + ve 为 0%，HER2 + ve 为 36%，TN 为 64%，P = 0.060）。三组患者从远处转移的中位生存时间有显著差异（28.3 vs. 29.1 vs. 11.8 个月，P < 0.0001）。然而，从 LM 开始的中位生存时间没有差异（4.1 vs. 5.9 vs. 3.8 个月，P = 0.226）。LM 的特征性表现和治疗结果可能受乳腺癌内在亚型独特生物学的影响。应该考虑包括全身化疗和局部治疗方式在内的积极联合治疗方式的不同作用，以改善预后。
