Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
Hematology/Oncology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Oncology. 2021;99(5):280-291. doi: 10.1159/000512212. Epub 2021 Mar 2.
The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis.
We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables.
In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race.
DISCUSSION/CONCLUSION: Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.
本研究旨在评估临床病理和社会经济学特征，以预测诊断时同时患有晚期乳腺癌伴脑转移的患者的生存改善情况。
我们利用国家癌症数据库（NCDB）确定了所有在诊断时即存在脑转移且受体状态（ER、PR、Her2）、临床 T 分期 cT1-4、临床 M1 有足够信息的患者，共有 3943 例患者可用于分析。通过稳健泊松回归模型研究脑转移模式与患者/疾病变量之间的关系。使用 Cox 比例风险模型来量化总生存期（OS）与这些变量之间的关联。
在单变量分析中，OS 与转移部位的数量显著相关（p<0.0001）。与仅存在脑转移的患者（中位 OS 10.6 个月，95%CI 9.4，12.9）或脑转移加一个其他颅外转移部位的患者（中位 OS 13.1 个月，95%CI 11.8，14.4）相比，有 2 个或更多其他颅外转移部位的患者的 OS 明显更差（中位 OS 8.8 个月，95%CI 7.8，9.9）。预测预后不良的危险因素包括三阴性疾病、高合并症评分、分化差的肿瘤、浸润性小叶组织学、转移多器官受累以及政府或缺乏保险。改善生存的因素包括年龄较小和西班牙裔。
讨论/结论：利用 NCDB，我们确定了与乳腺癌诊断时伴脑转移患者预后相关的各种因素。保险状况和相关的社会经济挑战为改善这些患者的护理提供了潜在的改进领域。这些信息可以帮助在诊断时将患者分层到预后类别中，以改善治疗计划。
