Wang Miao, Jensen Anders Bonde, Morgen Soeren Smith, Wu Chun Sen, Sun Ming, Li Haisheng, Dahl Benny, Bünger Cody Eric
Departments of *Orthopaedic E and †Oncology, Aarhus University Hospital NBG, Aarhus C, Denmark ‡Spine Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and §Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark.
Spine (Phila Pa 1976). 2014 Sep 1;39(19):1620-7. doi: 10.1097/BRS.0000000000000473.
We conducted a retrospective cohort study of 151 patients with breast cancer spinal metastases.
To investigate the influence of breast cancer subtypes on survival duration of patients with breast cancer spinal metastases, and to aid spine surgeons in selecting treatments on a more precise basis.
There is lack of knowledge about specific prognosis of patients with spinal metastases in various breast cancer subtypes. Estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (Her-2) status are the key factors in determining breast cancer subtypes and predicting patients' response to adjuvant treatments.
Until August 2013, we retrieved 151 surgically treated patients with breast cancer spinal metastases and followed up all the patients for at least 2 years. Survival duration analysis and Cox proportional hazards regression model unadjusted and adjusted by age were used.
Patients with ER-negative (-) breast cancer had 11 months shorter median survival duration (10.6 vs. 21.5 mo) and 48% higher mortality risk (P=0.03) than those with ER-positive (+) breast cancer. Patients with PgR (-) status had 59% higher mortality risk than those with PgR (+) status (P=0.02). Hormone receptor (HR) status is a combination of ER and PgR status. Patients with HR (-) status had an 11-month shorter median survival duration and 52% higher mortality risk (P=0.01) than patients with HR (+) status. Human epidermal growth factor receptor 2 subtypes had similar median survival duration and mortality risk. Patients with triple-negative breast cancer had a median survival duration of only 9.9 months.
Patients with spinal metastases with ER/HR (-) status and triple-negative breast cancer could be downgraded from score "5" to "3" in Tokuhashi scoring system and from "slow growth" to "moderate growth" in Tomita scoring system. Spine surgeons should be critical before performing high-risk extensive surgery in patients with ER/HR (-) status, and especially, in those with triple-negative status.
我们对151例乳腺癌脊柱转移患者进行了一项回顾性队列研究。
探讨乳腺癌亚型对乳腺癌脊柱转移患者生存时间的影响，并帮助脊柱外科医生更精确地选择治疗方法。
目前对于不同乳腺癌亚型脊柱转移患者的具体预后情况了解不足。雌激素受体（ER）、孕激素受体（PgR）和人表皮生长因子受体2（Her-2）状态是确定乳腺癌亚型和预测患者对辅助治疗反应的关键因素。
截至2013年8月，我们检索了151例接受手术治疗的乳腺癌脊柱转移患者，并对所有患者进行了至少2年的随访。采用生存时间分析以及年龄未校正和校正的Cox比例风险回归模型。
ER阴性（-）乳腺癌患者的中位生存时间比ER阳性（+）乳腺癌患者短11个月（10.6对21.5个月），死亡风险高48%（P = 0.03）。PgR（-）状态的患者比PgR（+）状态的患者死亡风险高59%（P = 0.02）。激素受体（HR）状态是ER和PgR状态的组合。HR（-）状态的患者中位生存时间比HR（+）状态的患者短11个月，死亡风险高52%（P = 0.01）。人表皮生长因子受体2亚型的中位生存时间和死亡风险相似。三阴性乳腺癌患者的中位生存时间仅为9.9个月。
在Tokuhashi评分系统中，ER/HR（-）状态和三阴性乳腺癌的脊柱转移患者可从“5分”降至“3分”，在Tomita评分系统中可从“生长缓慢”降至“生长中等”。脊柱外科医生在对ER/HR（-）状态，尤其是三阴性状态的患者进行高风险广泛手术前应持谨慎态度。
3级。
