伴有脑转移的乳腺癌：临床病理特征、生存情况及配对生物标志物分析。
Breast cancer with brain metastases: clinicopathologic features, survival, and paired biomarker analysis.
作者信息
Shen Qi, Sahin Aysegul A, Hess Kenneth R, Suki Dima, Aldape Kenneth D, Sawaya Raymond, Ibrahim Nuhad K
机构信息
Departments of Pathology, Biostatistics, Neurosurgery, and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Departments of Pathology, Biostatistics, Neurosurgery, and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
出版信息
Oncologist. 2015 May;20(5):466-73. doi: 10.1634/theoncologist.2014-0107. Epub 2015 Mar 23.
BACKGROUND
The aim of this study was to describe clinicopathologic features of patients with breast cancer brain metastasis (BCBM); to evaluate survival after diagnosis of BCBM; and to compare estrogen receptor (ER), progesterone receptor (PR), and HER2 expression in the paired primary and brain tumors.
MATERIALS AND METHODS
We identified 140 consecutive patients who underwent craniotomy for BCBM (either for diagnostic purpose or with therapeutic intent) at the University of Texas MD Anderson Cancer Center between 2002 and 2009.
RESULTS
Most patients had invasive ductal histology (91%), grade 3 tumors (67%), and positive axillary lymph node (64%). Of the tumors, 56% were ER-negative, 62% were PR-negative, 44% were HER2-positive, and 28% were triple negative (TN). Brain metastasis (BM) was solitary in 51% of patients. Median interval from breast cancer diagnosis to BM was 46 months; median survival after BM was 14.1 months. In the univariate analysis, younger age, solitary brain metastasis, and ER or PR positivity in the breast tumors were associated with longer survival. There was a statistical trend toward increased survival in HER2-positive patients compared with HER2-negative patients (18 vs. 11 months). In the multivariate analysis, predictors for longer survival included younger age, solitary brain lesion, and HER2 positivity in the breast cancer. Biomarkers were evaluated in paired primary and brain tumors in 35 patients for ER status, 34 for PR status, and 36 for HER2 status. Discordant rates were 28% for ER, 20% for PR, and 3% for HER2.
CONCLUSION
Compared with unselected breast cancer patients at the same institution, patients with breast cancer who had brain metastases had a higher proportion of hormone receptor-negative, HER2-positive, and TN tumors. Younger age, solitary brain lesion, and HER2 expression were independent predictors of better survival in patients with BCBM. HER2 status was highly concordant between the paired primary and brain tumors, whereas changes of ER and PR status occurred in a substantial proportion of the patients. These findings are important for making effective treatment decisions for patients with BCBM.
背景
本研究旨在描述乳腺癌脑转移（BCBM）患者的临床病理特征；评估BCBM诊断后的生存期；并比较配对的原发性肿瘤和脑肿瘤中雌激素受体（ER）、孕激素受体（PR）及人表皮生长因子受体2（HER2）的表达情况。
材料与方法
我们纳入了2002年至2009年间在德克萨斯大学MD安德森癌症中心因BCBM接受开颅手术（用于诊断或治疗目的）的140例连续患者。
结果
大多数患者的组织学类型为浸润性导管癌（91%），肿瘤分级为3级（67%），腋窝淋巴结阳性（64%）。其中，56%的肿瘤ER阴性，62%的肿瘤PR阴性，44%的肿瘤HER2阳性，28%的肿瘤为三阴性（TN）。51%的患者脑转移（BM）为单发。从乳腺癌诊断到发生BM的中位间隔时间为46个月；BM后的中位生存期为14.1个月。单因素分析中，年龄较小、单发脑转移以及乳腺肿瘤中ER或PR阳性与生存期较长相关。HER2阳性患者与HER2阴性患者相比，生存期有延长的统计学趋势（18个月对11个月）。多因素分析中，生存期较长的预测因素包括年龄较小、单发脑病变以及乳腺癌中HER2阳性。对35例患者的配对原发性肿瘤和脑肿瘤进行了ER状态评估，34例评估了PR状态，36例评估了HER2状态。ER的不一致率为28%，PR为20%，HER2为3%。
结论
与同一机构中未选择的乳腺癌患者相比，发生脑转移的乳腺癌患者中激素受体阴性、HER2阳性及TN肿瘤的比例更高。年龄较小、单发脑病变及HER2表达是BCBM患者生存期较好的独立预测因素。配对的原发性肿瘤和脑肿瘤之间HER2状态高度一致，而相当一部分患者的ER和PR状态发生了变化。这些发现对于为BCBM患者做出有效的治疗决策具有重要意义。
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