HER2 受体转化是乳腺癌脑转移患者的强生存预测因子。
HER2 Receptor Conversion Is a strong Survival Predictor in Patients with Breast Cancer Brain Metastases.
机构信息
Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
出版信息
World Neurosurg. 2021 Aug;152:e332-e343. doi: 10.1016/j.wneu.2021.05.096. Epub 2021 May 29.
BACKGROUND
Hormone and human epidermal growth factor receptor 2 (HER2/neu) receptor status is prognostic and predictive in breast cancer (BC) and guides the choice of therapy. However, owing to receptor conversion, the receptor status can differ in metastases compared with that of the primary tumor. The aim of the present study was to analyze the prognostic value of receptor status, receptor conversion, and clinical parameters in patients with resected BC brain metastases (BMs).
METHODS
Patients with BCBMs treated at our institution from July 2007 to December 2019 were eligible for the present study. The receptor status of the BC and corresponding BMs and the occurrence of receptor conversion were separately recorded for 3 common receptors: HER2/neu, estrogen receptor, and progesterone receptor. The association between the receptor status or receptor conversion and clinical parameters was adjusted for outcome-relevant patient and tumor characteristics.
RESULTS
The final analysis included 78 patients. HER2/neu receptor status in BMs was associated with overall survival (P = 0.033). Receptor conversion was identified in 39 patients (50.0%): HER2/neu, n = 9 (11.5%); estrogen receptor, n = 22 (28.2%); and progesterone receptor, n = 25 (32.1%). In the final multivariate Cox regression analysis, HER2/neu receptor conversion (adjusted hazard ratio [aHR], 3.58; P = 0.006), Karnofsky performance status score <70% (aHR, 3.11; P = 0.048), infratentorial BM location (aHR, 2.49; P = 0.007), and age ≥55 years at BM diagnosis (aHR, 2.20; P = 0.046) were independently associated with poorer survival.
CONCLUSIONS
Of the 3 common BC receptors, only HER2/neu receptor conversion was strongly associated with the prognosis of patients with surgically treated BCBMs. The clinical relevance of the reevaluation of receptor status in BMs favors surgical treatment of patients with noneloquent BCBMs.
背景
激素和人表皮生长因子受体 2（HER2/neu）受体状态在乳腺癌（BC）中具有预后和预测价值，指导治疗选择。然而，由于受体转换，转移瘤的受体状态可能与原发肿瘤不同。本研究旨在分析受体状态、受体转换和临床参数在接受手术治疗的乳腺癌脑转移（BM）患者中的预后价值。
方法
本研究纳入了 2007 年 7 月至 2019 年 12 月在我院接受治疗的 BCBM 患者。分别记录了 3 种常见受体（HER2/neu、雌激素受体和孕激素受体）的 BC 和相应 BM 的受体状态，以及受体转换的发生情况。对与结果相关的患者和肿瘤特征进行了调整，以分析受体状态或受体转换与临床参数之间的关系。
结果
最终分析纳入了 78 例患者。BM 中 HER2/neu 受体状态与总生存相关（P=0.033）。39 例患者（50.0%）发生了受体转换：HER2/neu 受体转换 9 例（11.5%），雌激素受体转换 22 例（28.2%），孕激素受体转换 25 例（32.1%）。在最终的多变量 Cox 回归分析中，HER2/neu 受体转换（调整后的危险比[aHR]，3.58；P=0.006）、卡氏功能状态评分<70%（aHR，3.11；P=0.048）、幕下 BM 位置（aHR，2.49；P=0.007）和 BM 诊断时年龄≥55 岁（aHR，2.20；P=0.046）是与生存较差独立相关的因素。
结论
在这 3 种常见的 BC 受体中，只有 HER2/neu 受体转换与接受手术治疗的 BCBM 患者的预后密切相关。对 BM 中受体状态进行重新评估的临床相关性支持对非语言区 BCBM 患者进行手术治疗。
Zotero 插件