Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
Center for Precision Medicine, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, 03080, Republic of Korea.
J Cancer Res Clin Oncol. 2018 Sep;144(9):1803-1816. doi: 10.1007/s00432-018-2697-2. Epub 2018 Jul 3.
PURPOSE: To evaluate the impact of molecular subtype on incidence and prognosis of brain metastasis from breast cancer. METHODS: The Surveillance, Epidemiology, and End Results (SEER) 18 registry was used to select breast cancer patients from 2010 to 2014. Molecular subtypes were classified as luminal A (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-), luminal B (HR+/HER2+), HER2 (HR-/HER2+), or triple negative breast cancer (TNBC) (HR-/HER2-). The incidence and prognosis of brain metastasis was evaluated according to molecular subtype. RESULTS: Among the 206913 breast cancer patients, the HER2 subtype showed the highest incidence of brain metastasis (1.0%). HER2 and TNBC with multiple extracranial metastases (bone, liver, and lung) showed a high incidence of brain metastasis (28.0 and 30.8%, respectively). Median survival of luminal A, luminal B, HER2, and TNBC in brain metastasis was 12, 23, 10, and 6 months (p < 0.001), and in brain metastasis without visceral metastasis was 14, 34, 17, and 8 months (p < 0.001). On multivariate analysis, the order of subtype by favorable prognosis was luminal B, luminal A, HER2, and TNBC in all brain metastasis, while for brain metastasis patients without visceral metastasis, the order was luminal B, HER2, luminal A, and TNBC. CONCLUSIONS: Molecular subtype and visceral metastasis should be considered for prediction of prognosis for patients with brain metastasis. The patients with HER2 and TNBC cancer subtypes having visceral metastasis, close surveillance could contribute to early detection of brain metastasis and may putatively lead to improved quality of life and survival.
目的:评估分子亚型对乳腺癌脑转移发生率和预后的影响。
方法:利用监测、流行病学和最终结果(SEER)18 登记处,从 2010 年至 2014 年选择乳腺癌患者。分子亚型分为 luminal A(激素受体[HR]+/人表皮生长因子受体 2 [HER2]-)、luminal B(HR+/HER2+)、HER2(HR-/HER2+)或三阴性乳腺癌(TNBC)(HR-/HER2-)。根据分子亚型评估脑转移的发生率和预后。
结果:在 206913 例乳腺癌患者中,HER2 亚型脑转移发生率最高(1.0%)。HER2 和具有多器官转移(骨、肝、肺)的 TNBC 脑转移发生率较高(分别为 28.0%和 30.8%)。脑转移患者中 luminal A、luminal B、HER2 和 TNBC 的中位生存时间分别为 12、23、10 和 6 个月(p<0.001),无脑转移的中位生存时间分别为 14、34、17 和 8 个月(p<0.001)。多变量分析显示,所有脑转移患者中,按预后良好的顺序依次为 luminal B、luminal A、HER2 和 TNBC;而无脑转移的脑转移患者,顺序依次为 luminal B、HER2、luminal A 和 TNBC。
结论:分子亚型和内脏转移应考虑用于预测脑转移患者的预后。HER2 和 TNBC 癌症亚型合并内脏转移的患者,密切监测有助于早期发现脑转移,可能提高生活质量和生存率。
J Cancer Res Clin Oncol. 2018-7-3
J Cancer Res Clin Oncol. 2018-4-19
Health Technol Assess. 2006-9
CA Cancer J Clin. 2016-1-7
Breast Cancer Res Treat. 2015-4
N Engl J Med. 2015-2-19
Cancer Cell. 2015-2-9