Minneapolis Radiation Oncology, University of Minnesota Gamma Knife, Minneapolis, MN, USA.
J Neurooncol. 2013 May;112(3):467-72. doi: 10.1007/s11060-013-1083-9. Epub 2013 Mar 6.
Our group has previously published the Diagnosis-Specific Graded Prognostic Assessment (GPA) showing the prognostic factors associated with survival in patients with brain metastases (BM). The purpose of this study is to investigate the relationship of breast cancer subtype to the time interval from primary diagnosis (PD) to development of BM (TPDBM), number of BM at initial BM presentation and survival. We analyzed our previously described multi-institutional retrospective database of 865 breast cancer patients treated for newly-diagnosed BM from 1993 to 2010. Several factors found to be associated with survival were incorporated into the Breast-GPA, including tumor subtype. The GPA database was further analyzed to determine if the subtype correlated with the TPDBM, number of BM, and survival from PD. After exclusions for incomplete data, 383 patients remained eligible for analysis. The subtypes were approximated as follows: Luminal B: triple positive; HER2: HER2 positive/ER/PR negative; Luminal A; ER/PR positive/HER2 negative; Basal: triple negative. Patients with Basal (90), HER2 (119), Luminal B (98) and Luminal A (76) tumor subtypes had a median TPDBM of 27.5, 35.8, 47.4 and 54.4 months (p < 0.01), median survival from PD of 39.6, 66.4, 90.3 and 72.7 months (p < 0.01) and median survival from BM of 7.3, 17.9, 22.9 and 10.0 months (p < 0.01), respectively. Tumor subtype is an important prognostic factor for survival in patients with breast cancer and BM. Although TPDBM is not an independent prognostic factor for survival (and thus not part of the Breast-GPA), the TPDBM does correlate with tumor subtype but does not correlate with the number of BM. Patients with Basal and HER2 tumor subtypes have short TPDBM. Prospective studies are needed to determine if screening brain MRIs are indicated in patients with Basal or HER2 subtypes.
我们的团队之前发表了特定于诊断的分级预后评估（GPA），该评估显示了与脑转移（BM）患者生存相关的预后因素。本研究的目的是探讨乳腺癌亚型与从原发性诊断（PD）到 BM 发展的时间间隔（TPDBM）、初始 BM 表现时的 BM 数量和生存之间的关系。我们分析了我们之前描述的 865 例乳腺癌患者的多机构回顾性数据库，这些患者在 1993 年至 2010 年期间接受了新诊断的 BM 治疗。将与生存相关的几个因素纳入了 Breast-GPA，包括肿瘤亚型。进一步分析 GPA 数据库，以确定亚型是否与 TPDBM、BM 数量和 PD 后的生存相关。排除数据不完整的患者后，有 383 例患者符合分析条件。亚型大致如下：Luminal B：三阳性；HER2：HER2 阳性/ER/PR 阴性；Luminal A；ER/PR 阳性/HER2 阴性；基底：三阴性。基底（90）、HER2（119）、Luminal B（98）和 Luminal A（76）肿瘤亚型患者的中位 TPDBM 分别为 27.5、35.8、47.4 和 54.4 个月（p<0.01），从 PD 到中位生存时间分别为 39.6、66.4、90.3 和 72.7 个月（p<0.01），从 BM 到中位生存时间分别为 7.3、17.9、22.9 和 10.0 个月（p<0.01）。肿瘤亚型是乳腺癌和 BM 患者生存的重要预后因素。虽然 TPDBM 不是生存的独立预后因素（因此不属于 Breast-GPA），但 TPDBM 与肿瘤亚型相关，但与 BM 数量无关。基底和 HER2 肿瘤亚型患者的 TPDBM 较短。需要前瞻性研究来确定是否在基底或 HER2 亚型患者中进行脑 MRI 筛查。
