Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Cancer Chemother Pharmacol. 2013 Jul;72(1):201-7. doi: 10.1007/s00280-013-2185-y. Epub 2013 May 14.
Leptomeningeal metastasis (LM) is one of the major problems in the management of metastatic breast cancer; typically, LM has a devastating prognosis and often represents a terminal event. The present study analyzed the clinical features and outcome of LM in patients with breast cancer.
The medical records of patients diagnosed with LM from breast cancer at Asan Medical Center, between 2002 and 2012, were reviewed retrospectively.
Of 95 LM patients, 38 (40 %) had an ECOG performance status (PS) ≤ 2, and the median age was 47 years (range 26-72 years). At the time of LM diagnosis, 46 patients (48.4 %) presented with coincidental failure of systemic disease control. Seventy-eight patients (82.1 %) underwent intrathecal (IT) chemotherapy, resulting in cytologic negative conversion in 26 patients, and 46 patients (48.4 %) received systemic chemotherapy. The median overall survival (OS) time was 3.3 months, and 7.8 % of the patients survived for more than 1 year. OS tended to be higher in patients who achieved cytologic negative conversion from IT chemotherapy than in those who did not (4.5 vs. 2.4 months, P = 0.088). Multivariate analysis demonstrated that ECOG PS ≤ 2, controlled extracranial disease at the time of LM diagnosis, and systemic chemotherapy after LM diagnosis were independent factors associated with survival.
The prognosis of patients with LM from breast cancer is poor. Systemic chemotherapy, in addition to intrathecal chemotherapy, might confer a survival benefit, even after the detection of LM.
脑膜转移（LM）是转移性乳腺癌治疗中的主要问题之一；通常，LM 的预后极差，往往代表着终末事件。本研究分析了乳腺癌患者 LM 的临床特征和转归。
回顾性分析 2002 年至 2012 年期间在 Asan 医疗中心诊断为 LM 的乳腺癌患者的病历。
在 95 例 LM 患者中，38 例（40%）ECOG 表现状态（PS）≤2，中位年龄为 47 岁（26-72 岁）。在 LM 诊断时，46 例（48.4%）同时出现全身疾病控制失败。78 例（82.1%）接受了鞘内（IT）化疗，26 例患者细胞学转阴，46 例（48.4%）接受了全身化疗。中位总生存期（OS）为 3.3 个月，7.8%的患者存活时间超过 1 年。与未达到 IT 化疗细胞学转阴的患者相比，达到转阴的患者 OS 更高（4.5 个月比 2.4 个月，P=0.088）。多因素分析表明，ECOG PS≤2、LM 诊断时颅外疾病得到控制以及 LM 诊断后接受全身化疗是与生存相关的独立因素。
乳腺癌 LM 患者的预后较差。除了鞘内化疗外，全身化疗在 LM 检测后也可能带来生存获益。
