Li Rong, Zhang Kui, Siegal Gene P, Wei Shi
Department of Pathology, the University of Alabama at Birmingham, Birmingham, AL 35249, USA.
Department of Mathematical Sciences, Michigan Technological University, Houghton, MI 49931, USA.
Hum Pathol. 2017 Jun;64:53-60. doi: 10.1016/j.humpath.2017.03.022. Epub 2017 Apr 17.
Brain metastasis from breast cancer generally represents a catastrophic event yet demonstrates substantial biological heterogeneity. There have been limited studies solely focusing on the prognosis of patients with such metastasis. In this study, we carried out a comprehensive analysis in 108 consecutive patients with breast cancer brain metastases between 1997 and 2012 to further define clinicopathological factors associated with early onset of brain metastasis and survival outcomes after development of them. We found that lobular carcinoma, higher clinical stages at diagnosis, and lack of coexisting bone metastasis were significantly associated with a worse brain relapse-free survival when compared with brain-only metastasis. High histologic grade, triple-negative breast cancer, and absence of visceral involvement were unfavorable prognostic factors after brain metastasis. Furthermore, high histologic grade, advanced tumor stages, and lack of coexisting bone involvement indicated a worse overall survival. Thus, the previously established prognostic factors in early stage or advanced breast cancers may not entirely apply to patients with brain metastases. Furthermore, the prognostic significance of the clinicopathological factors differed before and after a patient develops brain metastasis. This knowledge might help in establishing an algorithm to further stratify patients with breast cancer into prognostically significant categories for optimal prevention, screening, and treatment of their brain metastasis.
乳腺癌脑转移通常是一个灾难性事件，但具有显著的生物学异质性。仅专注于此类转移患者预后的研究有限。在本研究中，我们对1997年至2012年间连续的108例乳腺癌脑转移患者进行了全面分析，以进一步确定与脑转移早期发生及发生后生存结果相关的临床病理因素。我们发现，与单纯脑转移相比，小叶癌、诊断时较高的临床分期以及不存在并存骨转移与较差的无脑复发生存率显著相关。高组织学分级、三阴性乳腺癌以及不存在内脏受累是脑转移后的不良预后因素。此外，高组织学分级、晚期肿瘤分期以及不存在并存骨受累提示总体生存率较差。因此，先前在早期或晚期乳腺癌中确立的预后因素可能并不完全适用于脑转移患者。此外，临床病理因素的预后意义在患者发生脑转移前后有所不同。这一认识可能有助于建立一种算法，将乳腺癌患者进一步分层为具有预后意义的类别，以实现对其脑转移的最佳预防、筛查和治疗。
