多中心ESME数据库中孤立性中枢神经系统转移的乳腺癌患者的临床病理特征及预后
Clinicopathological characteristics and prognosis of breast cancer patients with isolated central nervous system metastases in the multicentre ESME database.
作者信息
Carausu Marcela, Carton Matthieu, Cabel Luc, Patsouris Anne, Levy Christelle, Verret Benjamin, Pasquier David, Debled Marc, Gonçalves Anthony, Desmoulins Isabelle, Lecouillard Isabelle, Bachelot Thomas, Ferrero Jean-Marc, Eymard Jean-Christophe, Mouret-Reynier Marie-Ange, Chevrot Michaël, De Maio Eleonora, Uwer Lionel, Frenel Jean-Sébastien, Leheurteur Marianne, Petit Thierry, Darlix Amélie, Bozec Laurence
机构信息
Department of Medical Oncology, Institut Curie, Saint-Cloud, France.
Department of Biostatistics, Institut Curie, Saint-Cloud, France.
出版信息
Ther Adv Med Oncol. 2022 Feb 26;14:17588359221077082. doi: 10.1177/17588359221077082. eCollection 2022.
BACKGROUND
As a result of progress in diagnosis and treatment, there is a growing prevalence of metastatic breast cancer (MBC) with isolated CNS metastases. This study describes the largest-to-date real-life cohort of this clinical setting and compares it to other clinical presentations.
METHODS
We retrospectively analysed the French Epidemiological Strategy and Medical Economics (ESME) MBC database including patients who initiated treatment for MBC between 2008 and 2016. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Descriptive statistics and multivariate Cox model were used.
RESULTS
Of 22,266 patients, 647 (2.9%) and 929 (4.2%) patients had isolated first-site CNS metastases or combined with extra-CNS metastases, with longer OS for the group with isolated CNS metastases (16.9 13.9 months, adjusted HR = 1.69 (95% CI: 1.50-1.91), < 0.001). Among the 541 (2.4%) patients with isolated CNS metastases and no intrathecal therapy (excluding leptomeningeal metastases), HER2+ cases were preponderant over TN or HR+ /HER2- cases (41.6% 26.1% 28.5%, respectively, < 0.01). The treatment strategy consisted of a combination of local treatment and systemic therapy (49.2%), local treatment only (35.5%) or systemic therapy only (11.4%), or symptomatic therapy only (3.9%). Median PFS was 6.1 months (95% CI: 5.7-6.8). Median OS was 20.7 months (95% CI: 17.3-24.3), reaching 37.9 months (95% CI: 25.9-47.6) in the HR+ /HER2+ subgroup. Older age, TN subtype, MBC-free interval of 6-12 months, lower performance status, and WBRT were associated with poorer survival. Patients who received systemic therapy within 3 months from MBC diagnosis had longer OS (24.1 16.1 months, = 0.031), but this was not significant on multivariate analysis [HR = 1.0 (95% CI: 0.7-1.3), = 0.806].
CONCLUSIONS
Patients with isolated CNS metastases at MBC diagnosis represent a distinct population for which the role of systemic therapy needs to be further investigated in prospective studies.
背景
由于诊断和治疗的进展，孤立性中枢神经系统转移的转移性乳腺癌（MBC）患病率不断上升。本研究描述了迄今为止该临床情况最大的真实世界队列，并将其与其他临床表现进行比较。
方法
我们回顾性分析了法国流行病学策略与医学经济学（ESME）MBC数据库，该数据库纳入了2008年至2016年间开始接受MBC治疗的患者个体。采用Kaplan-Meier方法估计无进展生存期（PFS）和总生存期（OS）。使用描述性统计和多变量Cox模型。
结果
在22266例患者中，647例（2.9%）和929例（4.2%）患者有孤立的首发中枢神经系统转移或合并中枢神经系统外转移，孤立性中枢神经系统转移组的OS更长（16.9对13.9个月，调整后HR = 1.69（95%CI：1.50 - 1.91），P < 0.001）。在541例（2.4%）有孤立性中枢神经系统转移且未接受鞘内治疗（不包括软脑膜转移）患者中，HER2 +病例比TN或HR + /HER2 -病例占优势（分别为41.6%对26.1%对28.5%，P < 0.01）。治疗策略包括局部治疗与全身治疗联合（49.2%）、仅局部治疗（35.5%）、仅全身治疗（11.4%）或仅对症治疗（3.9%）。中位PFS为6.1个月（95%CI：5.7 - 6.8）。中位OS为20.7个月（95%CI：17.3 - 24.3），HR + /HER2 +亚组达到37.9个月（95%CI：25.9 - 47.6）。年龄较大、TN亚型、MBC无病间期6 - 12个月、较低的体能状态和全脑放疗与较差的生存率相关。在MBC诊断后3个月内接受全身治疗的患者OS更长（24.1对16.1个月，P = 0.031），但在多变量分析中无显著差异[HR = 1.0（95%CI：0.7 - 1.3），P = 0.806]。
结论
MBC诊断时伴有孤立性中枢神经系统转移的患者代表了一个独特的群体，全身治疗的作用需要在前瞻性研究中进一步探讨。
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