转移性乳腺癌亚型与中枢神经系统转移

Metastatic breast cancer subtypes and central nervous system metastases.

作者信息

Aversa C, Rossi V, Geuna E, Martinello R, Milani A, Redana S, Valabrega G, Aglietta M, Montemurro F

机构信息

Division of Medical Oncology, Fondazione del Piemonte per l'Oncologia (FPO)-Candiolo Cancer Center (IRCCs), Turin, Italy; Department of Oncology, University of Torino Medical School, Italy.

Unit of Investigative Clinical Oncology (INCO), Fondazione del Piemonte per l'Oncologia (FPO)-Candiolo Cancer Center (IRCCs), Turin, Italy.

出版信息

Breast. 2014 Oct;23(5):623-8. doi: 10.1016/j.breast.2014.06.009. Epub 2014 Jun 30.

DOI:10.1016/j.breast.2014.06.009

PMID:24993072

Abstract

BACKGROUND

Breast cancer (BC) subtypes have different survival and response to therapy. We studied predictors of central nervous system metastases (CNS-M) and outcome after CNS-M diagnosis according to tumor subtype.

PATIENTS AND METHODS

488 patients with diagnosis of metastatic BC were retrospectively evaluated. According to the combination of hormone receptors (HR) and HER2 status, tumors were grouped in: Luminal (Lum), Luminal/HER2+, pure HER2-positive (pHER2+) and triple negative (TN). Time to CNS progression, CNS-M free interval and Overall Survival (OS) after CNS-M occurrence were compared by the log-rank test. Cox-proportional hazard models were used to study predictor factors associated with CNS progression, including tumor subtype and all potentially clinical relevant variables.

RESULTS

115 patients (pts) developed CNS-M with a median time to CNS progression of 31 months. The rate of CNS-M by subtype was: Lum 14%, Lum/HER2+ 35%, pHER2+ 49%, TN 22% (p < 0.001). Compared with Lum tumors, Lum/HER2+ (HR 2.514, p < 0.001), pHER2+ (HR 6.799, p < 0.0001) and TN (HR = 3.179, p < 0.001) subtypes were at higher risk of CNS-M. Median OS in months after CNS-M was: Lum 7.4, Lum/HER2+ 19.2, pHER2+ 7, TN 4.9 (p < 0.002). Belonging to the Lum/HER2+ subtype (HR 0.48, p < 0.037) and having isolated CNS (HR 0.37, p < 0.004) predicted significantly reduced risk of death.

CONCLUSIONS

After CNS-M, the Lum/HER2+ subtype appears associated with the longest OS. Prospective clinical trials would be required for evaluating the potential role of screening for asymptomatic CNS lesions and of more aggressive CNS-M treatment in Lum/HER2+ subtype.

摘要

背景

乳腺癌（BC）亚型具有不同的生存率和对治疗的反应。我们根据肿瘤亚型研究了中枢神经系统转移（CNS-M）的预测因素以及CNS-M诊断后的预后情况。

患者与方法

对488例诊断为转移性BC的患者进行回顾性评估。根据激素受体（HR）和HER2状态的组合，将肿瘤分为：腔面型（Lum）、腔面型/HER2阳性（Lum/HER2+）、单纯HER2阳性（pHER2+）和三阴性（TN）。通过对数秩检验比较CNS进展时间、无CNS-M间期和CNS-M发生后的总生存期（OS）。采用Cox比例风险模型研究与CNS进展相关的预测因素，包括肿瘤亚型和所有潜在的临床相关变量。

结果

115例患者发生CNS-M，CNS进展的中位时间为31个月。各亚型的CNS-M发生率分别为：Lum型14%，Lum/HER2+型35%，pHER2+型49%，TN型22%（p<0.001）。与Lum型肿瘤相比，Lum/HER2+型（HR 2.514，p<0.001）、pHER2+型（HR 6.799，p<0.0001）和TN型（HR = 3.179，p<0.001）亚型发生CNS-M的风险更高。CNS-M发生后以月为单位的中位OS分别为：Lum型7.4，Lum/HER2+型19.2，pHER2+型7，TN型4.9（p<0.002）。属于Lum/HER2+亚型（HR 0.48，p<0.037）和孤立性CNS转移（HR 0.37，p<0.004）预示死亡风险显著降低。