Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Clin Breast Cancer. 2018 Oct;18(5):353-361. doi: 10.1016/j.clbc.2017.12.009. Epub 2017 Dec 21.
Although brain metastases (BM) are associated with poor prognosis, patients with human epidermal growth factor receptor 2 (HER2) overexpressing (HER2) breast cancer (BC) with BM who are treated with anti-HER2 therapy have a relatively longer survival after BM diagnosis compared with other subtypes and HER2 patients previously untreated with anti-HER2 therapy. It is unclear if previously reported prognostic factors are applicable to patients with HER2 BC in the era of HER2-targeted therapy.
We evaluated 100 consecutive patients with HER2 BC with BM who underwent radiation therapy as primary BM treatment from January 2001 to December 2011 at Memorial Sloan Kettering Cancer Center by retrospective review. Patient characteristics at the time of BM diagnosis and their associations with time from BM to death were evaluated by Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models.
Significantly better survival from BM was noted for patients with higher performance status, fewer BM lesions, continued use of HER2-targeted therapy after BM diagnosis, and better controlled extracranial metastatic disease. Absence of neurologic symptoms at BM diagnosis was significantly associated with fewer lesions, decreased use of whole brain radiotherapy, and longer survival in univariate and multivariate analysis (multivariate hazard ratio, 3.69; 95% confidence interval, 1.69-8.07).
Our finding supports the continued use of HER2-targeted therapy after BM diagnosis. In addition, future research on the clinical impact of detecting asymptomatic BM in patients with HER2 BC, in terms of improving prognosis, quality of life, and avoidance of whole brain radiotherapy, is warranted.
尽管脑转移瘤（BM）与预后不良相关，但与其他亚型和未经抗 HER2 治疗的 HER2 患者相比，接受抗 HER2 治疗的 HER2 过表达（HER2）乳腺癌（BC）伴 BM 的患者在 BM 诊断后具有相对较长的生存时间。目前尚不清楚在 HER2 靶向治疗时代，以前报道的预后因素是否适用于 HER2 BC 患者。
我们通过回顾性分析，评估了 2001 年 1 月至 2011 年 12 月期间在纪念斯隆凯特琳癌症中心接受放射治疗作为原发性 BM 治疗的 100 例连续 HER2 BC 伴 BM 患者。通过 Kaplan-Meier 曲线、对数秩检验和 Cox 比例风险模型评估 BM 诊断时的患者特征及其与 BM 至死亡时间的关系。
发现患者的体能状态较高、BM 病变较少、BM 诊断后继续使用 HER2 靶向治疗以及更好地控制颅外转移性疾病时，从 BM 中获得的生存时间明显更长。BM 诊断时无神经系统症状与病变较少、全脑放疗使用率降低以及单变量和多变量分析中生存时间较长显著相关（多变量风险比，3.69；95%置信区间，1.69-8.07）。
我们的发现支持在 BM 诊断后继续使用 HER2 靶向治疗。此外，有必要就无症状 BM 在 HER2 BC 患者中的临床影响（改善预后、生活质量和避免全脑放疗）进行未来研究。
