Neuroscience Unit, National Institute of Cancer, Mexico City, Mexico.
Breast Cancer Unit, National Institute of Cancer, Mexico City, Mexico.
Cancer. 2020 Aug 1;126(15):3456-3463. doi: 10.1002/cncr.32928. Epub 2020 May 26.
The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm).
The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis.
Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P < .0001]), human epidermal growth factor receptor 2 (HER2)-positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P < .0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P < .001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P = .001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P < .0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months).
CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases.
本研究旨在确定乳腺癌（BC）诊断时与更高中枢神经系统转移（CNSm）率相关的因素。
作者分析了 2009 年 6 月至 2017 年 6 月期间在墨西哥城墨西哥国家癌症研究所因神经肿瘤咨询而转诊的确诊为 BC 患者的数据库。前瞻性收集信息，包括 BC 诊断时的人口统计学、病理和临床数据。建立了双变量和多变量逻辑回归模型，以估计 CNSm 发生与 BC 诊断后时间之间的关联。
在 970 例 BC 患者中，263 例（27%）被诊断为 CNSm。从 BC 诊断到 CNSm 发展的中位时间为 33 个月（四分位距，15-76 个月）。多变量分析后，BC 诊断时年龄<50 岁（比值比[OR]，2.5；95%置信区间[95%CI]，1.8-3.5[P<.0001]）、人表皮生长因子受体 2（HER2）阳性状态（HER2+）（OR，3.6；95%CI，2.1-6.1[P<.0001]）、管腔 B/HER2+亚型（OR，3.1；95%CI，1.9-5.3[P<.001]）、三阴性亚型（OR，2.4；95%CI，1.5-4[P=.001]）和卡氏功能状态评分≤70（OR，6.6；95%CI，4.5-9.6[P<.0001]）与 CNSm 发生率较高相关。脑实质是 CNSm 最常见的部位。CNSm 诊断后的中位总生存期为 12.2 个月（95%CI，9.3-15.1 个月）。
BC 患者中 CNSm 并不少见，特别是那些需要神经肿瘤评估且在诊断时年龄<50 岁、HER2+或三阴性亚型、卡氏功能状态评分较差且/或有≥2 个非 CNS 转移的患者。
