根据内在亚型对脑转移乳腺癌患者的治疗及预后
Treatment and prognosis of breast cancer patients with brain metastases according to intrinsic subtype.
作者信息
Kuba Sayaka, Ishida Mayumi, Nakamura Yoshiaki, Yamanouchi Kosho, Minami Shigeki, Taguchi Kenichi, Eguchi Susumu, Ohno Shinji
机构信息
Department of Breast Oncology, National Hospital Organization, Kyushu Cancer Center, Fukuoka Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
Department of Breast Oncology, National Hospital Organization, Kyushu Cancer Center, Fukuoka.
出版信息
Jpn J Clin Oncol. 2014 Nov;44(11):1025-31. doi: 10.1093/jjco/hyu126. Epub 2014 Aug 25.
OBJECTIVE
How breast cancer subtypes should affect treatment decisions for breast cancer patients with brain metastases is unclear. We analyzed local brain metastases treatments and their outcomes according to subtype in patients with breast cancer and brain metastases.
METHODS
We reviewed records and database information for women treated at the National Kyushu Cancer Center between 2001 and 2010. Patients were divided into three breast cancer subtype groups: Luminal (estrogen receptor positive and/or progesterone receptor positive, but human epidermal growth factor receptor 2 negative); human epidermal growth factor receptor 2 positive and triple negative (estrogen receptor negative, progesterone receptor negative and human epidermal growth factor receptor 2 negative).
RESULTS
Of 524 advanced breast cancer patients, we reviewed 65 (12%) with brain metastases and records showing estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status, as well as outcome data; there were 26 (40%) Luminal, 26 (40%) had human epidermal growth factor receptor 2 and 13 (20%) had triple negative subtypes. There was no statistical difference in the number of brain metastases among subtypes; however, rates of stereotactic radiosurgery or surgery for brain metastases differed significantly by subtype (human epidermal growth factor receptor 2: 81%, Luminal: 42% and triple negative: 47%; P = 0.03). Patients having the human epidermal growth factor receptor 2 subtype, a performance status of ≤1 and ≤4 brain metastases, who underwent systemic therapy after brain metastases and underwent stereotactic radiosurgery or surgery, were predicted to have longer overall survival after brain metastases. Multivariate analysis demonstrated that not having systemic therapy and not having the human epidermal growth factor receptor 2 subtype were independent factors associated with an increased risk of death (hazard ratio 2.4, 95% confidence interval 1.01-5.6; P = 0.05 and hazard ratio 2.9, 95% confidence interval 1.5-5.8; P = 0.003, respectively).
CONCLUSION
Our study showed that local brain treatments and prognosis differed by subtype in breast cancer patients with brain metastases.
目的
目前尚不清楚乳腺癌亚型应如何影响伴有脑转移的乳腺癌患者的治疗决策。我们根据乳腺癌和脑转移患者的亚型分析了局部脑转移瘤的治疗方法及其疗效。
方法
我们回顾了2001年至2010年在国立九州癌症中心接受治疗的女性患者的病历和数据库信息。患者被分为三个乳腺癌亚型组：管腔型（雌激素受体阳性和/或孕激素受体阳性，但人表皮生长因子受体2阴性）；人表皮生长因子受体2阳性和三阴性（雌激素受体阴性、孕激素受体阴性和人表皮生长因子受体2阴性）。
结果
在524例晚期乳腺癌患者中，我们回顾了65例（12%）伴有脑转移且记录显示雌激素受体、孕激素受体和人表皮生长因子受体2状态以及预后数据的患者；其中26例（40%）为管腔型，26例（40%）为人表皮生长因子受体2阳性，13例（20%）为三阴性亚型。各亚型之间脑转移瘤的数量无统计学差异；然而，脑转移瘤的立体定向放射外科手术或手术率因亚型而异（人表皮生长因子受体2阳性：81%，管腔型：42%，三阴性：47%；P = 0.03）。人表皮生长因子受体2亚型、体能状态≤1且脑转移瘤≤4个、在脑转移瘤后接受全身治疗并接受立体定向放射外科手术或手术的患者，预计脑转移瘤后的总生存期更长。多因素分析表明，未接受全身治疗和非人表皮生长因子受体2亚型是与死亡风险增加相关的独立因素（风险比分别为2.4，95%置信区间1.01 - 5.6；P = 0.05和风险比2.9，95%置信区间1.5 - 5.8；P = 0.003）。
结论
我们的研究表明，伴有脑转移的乳腺癌患者中，局部脑治疗和预后因亚型而异。
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