Department of Medical Oncology, Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Department of Epidemiology, University of Iowa College of Public Health.
Am J Clin Oncol. 2019 Jan;42(1):60-66. doi: 10.1097/COC.0000000000000477.
The main objective of this study was to analyze treatment patterns of elderly patients with breast cancer brain metastases (BCBM), evaluate characteristics associated with treatment selection, and to analyze trends in overall survival (OS) over time.
We included women with BCBM reported to the Surveillance, Epidemiology, and End Results Medicare Program from 1992 to 2012. Treatments were recorded from Medicare claims from the date of brain metastases diagnosis until 60 days after. Treatments included resection, radiation, and chemotherapy. Cochran-Armitage tests were used for analysis of treatment patterns. Multinomial logistic regression was applied to determine factors associated with treatment selection. Cox regression modelled OS trends within each treatment modality across time.
Among 5969 patients included, treatment rates increased from 50% in 1992 to 64.1% in 2012 (P<0.01). Therapy combining radiation, resection, and/or chemotherapy also increased from 8.8% to 18% over the same period (P<0.01). Combined therapy was significantly more likely among patients with extracranial metastases, those with estrogen-negative tumors, younger age at diagnosis, no comorbidities and more recently diagnosed brain metastases. OS improved over time for patients who received a combination of ≥2 treatments (hazard ratio, 0.89 per every 5 more recent diagnosis years; P<0.05). Older patients, those with extracranial metastases, or estrogen/progesterone-negative tumors showed significantly shorter OS.
We observed substantial changes in treatment patterns and OS over time in patients with BCBM. We identified several factors associated with specific treatment use. Patients who underwent a combination of ≥2 treatments experienced a significant improvement in OS over time.
本研究的主要目的是分析老年乳腺癌脑转移（BCBM）患者的治疗模式，评估与治疗选择相关的特征，并分析随时间推移的总生存（OS）趋势。
我们纳入了 1992 年至 2012 年向监测、流行病学和最终结果 Medicare 计划报告的有 BCBM 的女性患者。治疗记录来自脑转移诊断日期至 60 天后的 Medicare 索赔。治疗包括切除、放疗和化疗。Cochran-Armitage 检验用于分析治疗模式。多分类逻辑回归用于确定与治疗选择相关的因素。Cox 回归模型分析了每种治疗模式随时间的 OS 趋势。
在纳入的 5969 例患者中，治疗率从 1992 年的 50%增加到 2012 年的 64.1%（P<0.01）。同期，联合放疗、切除术和/或化疗的治疗也从 8.8%增加到 18%（P<0.01）。联合治疗在有颅外转移、雌激素阴性肿瘤、诊断时年龄较小、无合并症和最近诊断为脑转移的患者中更为常见。接受≥2 种治疗的患者的 OS 随时间延长而改善（风险比，每增加 5 年最近诊断时间降低 0.89；P<0.05）。较年长的患者、有颅外转移或雌激素/孕激素阴性肿瘤的患者 OS 明显缩短。
我们观察到 BCBM 患者的治疗模式和 OS 随时间发生了重大变化。我们确定了与特定治疗方法相关的几个因素。接受≥2 种治疗的患者的 OS 随时间显著改善。
