Academic Trials Promoting Team, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B), Belgium.
Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
Breast. 2021 Jun;57:86-94. doi: 10.1016/j.breast.2021.03.002. Epub 2021 Mar 23.
BACKGROUND/METHODS: Although the prognosis of metastatic breast cancer (BC) has improved, some patients still develop high burden metastases or visceral crisis (VC) and polychemotherapy is commonly used in these cases. Data reporting the real effectiveness of this strategy are scanty. Therefore, the outcomes of patients with metastatic BC treated with platinum-based chemotherapy (P-ChT) at the Jules Bordet Institute during the period of January 2008 and December 2018 were retrospectively reviewed. The presence of VC was defined according to ABC 4 criteria.
441 patients were identified: visceral metastases were observed in 430 (97.5%) while 261 (59.2%) presented VC. As for metastatic BC subtype, 255 (57.8%) had ER-positive/HER2-negative, 41 (9.3%) ER-positive/HER2-positive, 34 (7.7%) ER-negative/HER2-positive and 111 (25.1%) triple-negative BC. Median number of prior treatment lines was 3.8 (0-12). Median OS with P-ChT in the entire cohort was 6.13 months. Patients with VC had lower OS than patients without VC (8.6 vs 3.7 months; p < 0.001). On multivariate analysis, the variables correlated with worse OS were hyperbilirubinemia (HR 1.90; 95% CI 1.34-2.75), ECOG ≥2 (HR 1.77; 95% CI 1.13-2.78) and ECOG ≥3 (HR 2.52; 95% CI 1.48-4.28), and >3 previous treatment lines (HR 2.27; 95% CI 1.53-3.21). Of the 261 patients with VC, 106 (40.5%) presented a resolution of the VC which correlated with better OS (9.3 vs 2.0 months, HR 0.27; 95% CI 0.21-0.36).
Patients who overcome VC benefit from P-ChT with OS similar to patients without VC. In this analysis, hyperbilirubinemia, poor ECOG and >3 previous treatment lines were significant prognostic factors in the overall study population.
背景/方法：尽管转移性乳腺癌（BC）的预后有所改善，但仍有部分患者发生高负担转移或内脏危象（VC），通常采用多化疗方案进行治疗。但目前有关该策略实际效果的数据仍较少。因此，我们回顾了 2008 年 1 月至 2018 年 12 月期间在 Jules Bordet 研究所接受铂类化疗（P-ChT）治疗的转移性 BC 患者的结局。根据 ABC4 标准定义 VC 的存在。
共纳入 441 例患者：430 例（97.5%）患者存在内脏转移，261 例（59.2%）患者存在 VC。对于转移性 BC 亚型，255 例（57.8%）为 ER 阳性/HER2 阴性，41 例（9.3%）为 ER 阳性/HER2 阳性，34 例（7.7%）为 ER 阴性/HER2 阳性，111 例（25.1%）为三阴性 BC。中位既往治疗线数为 3.8（0-12）。整个队列中接受 P-ChT 治疗的患者中位 OS 为 6.13 个月。有 VC 的患者 OS 低于无 VC 的患者（8.6 个月 vs 3.7 个月；p<0.001）。多变量分析显示，与较差 OS 相关的变量为高胆红素血症（HR 1.90；95%CI 1.34-2.75）、ECOG≥2（HR 1.77；95%CI 1.13-2.78）和 ECOG≥3（HR 2.52；95%CI 1.48-4.28），以及既往治疗线数>3（HR 2.27；95%CI 1.53-3.21）。在 261 例有 VC 的患者中，有 106 例（40.5%）患者的 VC 得到缓解，其 OS 更好（9.3 个月 vs 2.0 个月，HR 0.27；95%CI 0.21-0.36）。
克服 VC 的患者接受 P-ChT 治疗可获得与无 VC 患者相似的 OS。在这项分析中，高胆红素血症、较差的 ECOG 和>3 条既往治疗线是整个研究人群中的显著预后因素。
