Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Breast J. 2019 May;25(3):363-372. doi: 10.1111/tbj.13230. Epub 2019 Mar 28.
Triple negative breast cancer (TNBC) has worse prognosis than other subtypes of breast cancer, and many patients develop brain metastasis (BM). We developed a simple predictive model to stratify the risk of BM in TNBC patients receiving neo-adjuvant chemotherapy (NAC), surgery, and radiation therapy (RT).
Patients with TNBC who received NAC, surgery, and RT were included. Cox proportional hazards method was used to evaluate factors associated with BM. Significant factors predictive for BM on multivariate analysis (MVA) were used to develop a risk score. Patients were divided into three risk groups: low, intermediate, and high. A receiver operating characteristic (ROC) curve was drawn to evaluate the value of the risk group in predicting BM. This predictive model was externally validated.
A total of 160 patients were included. The median follow-up was 47.4 months. The median age at diagnosis was 49.9 years. The 2-year freedom from BM was 90.5%. Persistent lymph node positivity, HR 8.75 (1.76-43.52, P = 0.01), and lack of downstaging, HR 3.46 (1.03-11.62, P = 0.04), were significant predictors for BM. The 2-year rate of BM was 0%, 10.7%, and 30.3% (P < 0.001) in patients belonging to low-, intermediate-, and high-risk groups, respectively. Area under the ROC curve was 0.81 (P < 0.001). This model was externally validated (C-index = 0.79).
Lack of downstaging and persistent lymph node positivity after NAC are associated with development of BM in TNBC. This model can be used by the clinicians to stratify patients into the three risk groups to identify those at increased risk of developing BM and potentially impact surveillance strategies.
三阴性乳腺癌（TNBC）的预后比其他乳腺癌亚型差，许多患者会发生脑转移（BM）。我们开发了一种简单的预测模型，以对接受新辅助化疗（NAC）、手术和放射治疗（RT）的 TNBC 患者的 BM 风险进行分层。
纳入接受 NAC、手术和 RT 的 TNBC 患者。采用 Cox 比例风险方法评估与 BM 相关的因素。多变量分析（MVA）中对 BM 有预测意义的显著因素用于建立风险评分。患者被分为低、中、高三个风险组。绘制受试者工作特征（ROC）曲线以评估风险组预测 BM 的价值。该预测模型经过外部验证。
共纳入 160 例患者。中位随访时间为 47.4 个月。中位诊断年龄为 49.9 岁。2 年无 BM 生存率为 90.5%。持续性淋巴结阳性，HR 8.75（1.76-43.52，P=0.01）和降期不足，HR 3.46（1.03-11.62，P=0.04）是 BM 的显著预测因素。低、中、高危组患者 2 年 BM 发生率分别为 0%、10.7%和 30.3%（P<0.001）。ROC 曲线下面积为 0.81（P<0.001）。该模型经过外部验证（C 指数=0.79）。
NAC 后降期不足和持续性淋巴结阳性与 TNBC 患者 BM 的发生相关。该模型可用于临床医生将患者分为三个风险组，以识别那些发生 BM 风险增加的患者，并可能影响监测策略。
