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乳腺癌亚型和分期是从乳腺癌诊断到脑转移发展时间的预后因素。

Breast cancer subtype and stage are prognostic of time from breast cancer diagnosis to brain metastasis development.

机构信息

Department of Radiation Oncology, Columbia University Medical Center, CHONY North Basement Room 11, 622 West 168 Street, New York, NY, 10032, USA.

Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, 710 West 168 Street, New York, NY, USA.

出版信息

J Neurooncol. 2017 Sep;134(2):453-463. doi: 10.1007/s11060-017-2549-y. Epub 2017 Jul 3.

Abstract

Breast cancer brain metastasis (BCBM) is associated with high morbidity and mortality. Patients with breast cancer risk factors associated with rapid development of BCBM could potentially benefit from early brain metastasis screening. We retrospectively reviewed all BCBM patients treated with brain radiotherapy at our institution from 1997 to 2015. Interval time to BCBM was defined as date of pathologic breast cancer diagnosis to date of radiographic evidence of brain metastasis. Patients were stratified by breast cancer molecular subtype and stage at diagnosis. Kaplan Meier analysis was conducted on time to development of BCBM. Breast cancer risk factors were correlated with time to BCBM on Cox proportion hazard analysis. The study cohort comprised 121 BCBM patients, with median interval time to BCBM of 46 months. Times to BCBM for Her2+/2HR+, Her2+, Her2-/HR+, and triple-negative (TNBC) subtypes were 70, 44, 42, and 28 months respectively (p = 0.002). Time to BCBM for stages I, II, III, and IV were 70, 54, 29, and 24 months, respectively (p = 0.000). BCBM patients were further stratified by both molecular subtype (TNBC vs. non-TNBC) and stage (I, II vs. III, IV). Median times to BCBM for non-TNBC/stage I-II, TNBC/stage I-II, non-TNBC stage III-IV, and TNBC/stage III-IV were 68, 47, 29, and 6 months respectively (p = 0.000). Subtype and stage were associated with shorter time to BCBM on multivariate analysis. Subtype and initial stage are independently correlated with decreased time to development of BCBM. Patients with advanced high stage and triple negative breast cancer develop brain metastases significantly earlier.

摘要

乳腺癌脑转移(BCBM)与高发病率和死亡率相关。具有与 BCBM 快速发展相关的乳腺癌风险因素的患者可能受益于早期脑转移筛查。我们回顾性分析了自 1997 年至 2015 年在我院接受脑部放疗的所有 BCBM 患者。BCBM 的间隔时间定义为病理乳腺癌诊断日期至脑部转移的影像学证据日期。患者按乳腺癌分子亚型和诊断时的分期进行分层。采用 Kaplan-Meier 分析方法分析发生 BCBM 的时间。采用 Cox 比例风险分析对乳腺癌风险因素与 BCBM 时间进行相关性分析。研究队列包括 121 例 BCBM 患者,BCBM 的中位间隔时间为 46 个月。Her2+/2HR+、Her2+、Her2-/HR+和三阴性(TNBC)亚型的 BCBM 时间分别为 70、44、42 和 28 个月(p=0.002)。I、II、III 和 IV 期的 BCBM 时间分别为 70、54、29 和 24 个月(p=0.000)。根据分子亚型(TNBC 与非-TNBC)和分期(I、II 与 III、IV)进一步对 BCBM 患者进行分层。非-TNBC/分期 I-II、TNBC/分期 I-II、非-TNBC 分期 III-IV 和 TNBC/分期 III-IV 的中位 BCBM 时间分别为 68、47、29 和 6 个月(p=0.000)。多变量分析显示,亚型和分期与 BCBM 时间较短相关。在多变量分析中,亚型和初始分期与 BCBM 发生时间缩短独立相关。晚期高分期和三阴性乳腺癌患者发生脑转移的时间明显更早。

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