Department of Breast Cancer and Reconstructive Surgery, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgen 5 Str., 02-781, Warsaw, Poland.
Bioinformatics and Biostatistics Unit, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, 02-781, Warsaw, Poland.
J Neurooncol. 2018 May;138(1):191-198. doi: 10.1007/s11060-018-2790-z. Epub 2018 Feb 12.
The study aimed to assess factors affecting survival of breast cancer patients suffering leptomeningeal metastasis (LM) and to compare survivals in patients with LM as the first and only site of metastases at presentation to patients with LM and metastases in other organs, along with selecting a patient group which had the best survival outcomes. Subject groups consisted of 187 patients consecutively referred during 1999-2015. A Cox proportional hazards model was used to identify factors associated with prolonged survival from LM. The Cox prognostic index was created to identify the group of patients with the most favorable prognosis. Median survival for all patients and for those with LM as the first site of metastases at presentation was 17 weeks and 1 year-survival was 15 and 16%, respectively. Factors beneficially affecting survival were: KPS ≥ 70, older age, biological subtype ER/PR+HER2-, systemic treatment, intrathecal treatment and radiation therapy. Based on these factors, 4 prognostic groups were found, with the most favorable group being 24 LM patients with median survival of 9.6 months. In this group, all patients were treated systemically and all were irradiated, 88% had KPS ≥ 70, about 80% had luminal breast cancer, 75% were treated intrathecally and 58% were more than 53 years old. Out of 4 prognostic groups of patients with LM, the most favorable group was selected. The median survival of breast cancer patients with the leptomeninges as the only site of metastases was comparable to those who had metastases in the leptomeninges and in other organs.
本研究旨在评估影响乳腺癌脑膜转移（LM）患者生存的因素，并比较首发且仅为 LM 转移与 LM 合并其他器官转移患者的生存情况，同时选择生存预后最佳的患者群体。研究对象为 1999 年至 2015 年连续就诊的 187 例患者。采用 Cox 比例风险模型确定与 LM 延长生存相关的因素。创建 Cox 预后指数以确定预后最佳的患者群体。所有患者和首发 LM 转移患者的中位生存期分别为 17 周和 1 年生存率分别为 15%和 16%。有益影响生存的因素有：KPS≥70、年龄较大、生物学亚型 ER/PR+HER2-、全身治疗、鞘内治疗和放疗。基于这些因素，发现了 4 个预后组，其中最有利的一组是 24 例 LM 患者，中位生存期为 9.6 个月。在这一组中，所有患者均接受了全身治疗和放疗，88%的患者 KPS≥70，约 80%的患者为腔型乳腺癌，75%的患者接受了鞘内治疗，58%的患者年龄超过 53 岁。在 LM 患者的 4 个预后组中，选择了最有利的一组。首发且仅为 LM 转移的乳腺癌患者的中位生存期与同时存在 LM 和其他器官转移的患者相当。
