Maurer Christian, Tulpin Lorraine, Moreau Michel, Dumitrescu Cristina, de Azambuja Evandro, Paesmans Marianne, Nogaret Jean-Marie, Piccart Martine J, Awada Ahmad
Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.
Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
ESMO Open. 2018 Oct 24;3(6):e000440. doi: 10.1136/esmoopen-2018-000440. eCollection 2018.
Patients with metastatic human epidermal growth factor receptor 2-positive breast cancer (HER2+ BC) frequently experience brain metastases (BM). We aimed to define risk factors for the development of BM in patients with HER2+ BC and to report on their outcome.
This is a retrospective analysis of patients diagnosed with HER2+ BC between January 2000 and December 2014 at Institut Jules Bordet, Belgium. Statistical analyses were conducted with SAS V.9.4 using Kaplan-Meier method and Cox regression analyses.
A total of 483 patients were included of whom 108 (22.4%) developed metastases and 52 (10.8%) BM. Among 96 metastatic patients without BM at diagnosis, 40 (41.7%) developed BM in the course of their disease. In multivariate analysis, risk factors for the development of BM were age ≤40 years (HR 2.10, 95 % CI 1.02 to 4.36), tumour size >2 cm (HR 4.94, 95% CI 1.69 to 14.47), nodal involvement (HR 3.48, 95% CI 1.47 to 8.25), absence or late start (≥6 months after initial diagnosis) of adjuvant anti-HER2 treatment (HR 3.79, 95% CI 1.52 to 9.43 or HR 2.65, 95% CI 1.03 to 6.82) and the development of lung metastases as first site of relapse (HR 6.97, 95% CI 3.41 to 14.24). Twenty-two patients with HER2+ BC and BM sent to our institute for further treatment were included in the outcome analysis. Asymptomatic patients at the time of BM diagnosis showed a better overall survival than symptomatic patients (HR 0.49, 95% CI 0.25 to 0.94).
A considerable number of patients with metastatic HER2+ BC will develop BM. Screening of patients with risk factors for BM might lead to early detection and better outcome. However, randomised controlled trials examining the use of MRI as a screening method for BM in patients with metastatic BC are warranted before such an approach can be recommended.
转移性人表皮生长因子受体2阳性乳腺癌（HER2+ BC）患者经常发生脑转移（BM）。我们旨在确定HER2+ BC患者发生BM的危险因素并报告其预后情况。
这是一项对2000年1月至2014年12月在比利时朱尔斯·博尔代研究所诊断为HER2+ BC的患者的回顾性分析。使用SAS V.9.4软件，采用Kaplan-Meier法和Cox回归分析进行统计分析。
共纳入483例患者，其中108例（22.4%）发生转移，52例（10.8%）发生BM。在96例诊断时无BM的转移性患者中，40例（41.7%）在疾病过程中发生了BM。多因素分析显示，发生BM的危险因素包括年龄≤40岁（HR 2.10，95%CI 1.02至4.36）、肿瘤大小>2 cm（HR 4.94，95%CI 1.69至14.47）、淋巴结受累（HR 3.48，95%CI 1.47至8.25）、辅助抗HER2治疗缺失或开始较晚（初始诊断后≥6个月）（HR 3.79，95%CI 1.52至9.43或HR 2.65，95%CI 1.03至6.82）以及作为首发复发部位出现肺转移（HR 6.97，95%CI 3.41至14.24）。22例因HER2+ BC和BM前来我院进一步治疗的患者纳入预后分析。BM诊断时无症状的患者总生存期优于有症状的患者（HR 0.49，95%CI 0.25至0.94）。
相当数量的转移性HER2+ BC患者会发生BM。对有BM危险因素的患者进行筛查可能会实现早期发现并改善预后。然而，在推荐这种方法之前，有必要进行随机对照试验，以研究将MRI作为转移性BC患者BM筛查方法的应用情况。
