Laakmann Elena, Witzel Isabell, Neunhöffer Tanja, Weide Rudolf, Schmidt Marcus, Park-Simon Tjoung-Won, Möbus Volker, Mundhenke Christoph, Polasik Arkadius, Lübbe Kristina, Hesse Tobias, Riecke Kerstin, Thill Marc, Fasching Peter A, Denkert Carsten, Fehm Tanja, Nekljudova Valentina, Rey Julia, Loibl Sibylle, Müller Volkmar
Department of Gynecology, Martinistraße 52, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
Frauenärzte am Dom, Rheinstraße 33, 55116 Mainz, Germany.
Cancers (Basel). 2020 Sep 28;12(10):2787. doi: 10.3390/cancers12102787.
: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. : The aim of this analysis was to characterize patients with asymptomatic BM ( = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. : Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, = 0.01), had a better performance status at diagnosis (Karnofsky index 80-100%: 68.4% vs. 57%, < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, < 0.001). : These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
脑转移(BM)已成为转移性乳腺癌患者面临的一项重大挑战。本分析的目的是对德国乳腺癌脑转移网络(BMBC)登记处2589例脑转移患者的总体队列中580例无症状脑转移患者的特征进行描述。与有症状的患者相比,无症状患者诊断时年龄稍小(中位年龄:55.5岁对57.0岁,P = 0.01),诊断时体能状态更好(卡诺夫斯基指数80 - 100%:68.4%对57%,P < 0.001),脑转移灶数量较少(>1个脑转移灶:56%对70%,P = 0.027),且脑转移灶直径稍小(中位值:1.5 cm对2.2 cm,P < 0.001)。无症状患者更可能有颅外转移(86.7%对81.5%,P = 0.003),但发生软脑膜转移的可能性较小(6.3%对10.9%,P < 0.001)。与有症状的患者相比,无症状患者接受的脑转移治疗强度较低,但中位总生存期较长(对HER2阳性患者队列具有统计学意义)(10.4个月对6.9个月,P < 0.001)。这些分析显示出一种趋势,即无症状患者的转移性脑疾病较轻,尽管局部脑转移治疗强度较低,但与有症状的脑转移患者相比仍有更好的结局(对HER2阳性患者队列具有统计学意义),尽管不能排除早期诊断的领先时间偏倚。在研究脑转移早期检测和治疗益处的潜在试验背景下,我们的分析具有临床相关性。