Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Department of Neurology, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.
Breast Cancer Res Treat. 2022 Jul;194(2):365-384. doi: 10.1007/s10549-022-06605-4. Epub 2022 Jun 9.
As survival of patients with central nervous system (CNS) metastases from breast cancer is poor and incidence rates are increasing, there is a growing need for better treatment strategies. In the current study, the efficacy of local and systemic therapies was analyzed in breast cancer patients with CNS metastases.
Medical records from breast cancer patients with brain and/or leptomeningeal metastases (LM) treated at a tertiary referral center and a teaching hospital between 2010 and 2020 were retrospectively studied. Main outcomes of interest were overall survival (OS) and CNS progression free survival. Analyses were performed among patients with brain metastases (BM) and patients with LM, for the different systemic and local therapies for CNS metastases, and for subgroups based on breast cancer subtypes.
We identified 155 patients, 97 with BM and 58 with LM. Median OS was 15.9 months for patients with BM and 1.5 months for patients with LM. Median OS was significantly longer for HER2-positive patients with BM (22.8 months) vs triple negative (8.4 months) and hormone receptor positive/HER2-negative (5.9 months) (P < 0.001). Patients with BM receiving both local and systemic therapy also had a longer median OS (21.8 months), compared to the other three subgroups (local therapy only: 9.9 months, systemic therapy only: 4.3 months, no therapy: 0.5 months, P < 0.001). No significant difference in OS was observed between different systemic treatment regimens.
Breast cancer patients with BM show longest median OS when the subtype is HER2-positive and when they are treated with both local and systemic therapy.
由于乳腺癌中枢神经系统（CNS）转移患者的生存率较差且发病率不断上升，因此需要更好的治疗策略。本研究分析了乳腺癌伴 CNS 转移患者的局部和全身治疗效果。
回顾性研究了 2010 年至 2020 年间，在一家三级转诊中心和一家教学医院治疗的脑和/或软脑膜转移（LM）乳腺癌患者的病历。主要观察终点为总生存（OS）和 CNS 无进展生存。对脑转移（BM）患者和 LM 患者、不同的 CNS 转移全身和局部治疗以及基于乳腺癌亚型的亚组进行了分析。
共纳入 155 例患者，其中 97 例有 BM，58 例有 LM。BM 患者的中位 OS 为 15.9 个月，LM 患者的中位 OS 为 1.5 个月。BM 中 HER2 阳性患者的中位 OS 明显长于三阴性（8.4 个月）和激素受体阳性/HER2 阴性（5.9 个月）（P < 0.001）。同时接受局部和全身治疗的 BM 患者中位 OS 也更长（21.8 个月），与其他三组（仅局部治疗：9.9 个月；仅全身治疗：4.3 个月；无治疗：0.5 个月；P < 0.001）相比。不同全身治疗方案之间的 OS 无显著差异。
当亚型为 HER2 阳性且同时接受局部和全身治疗时，BM 乳腺癌患者的中位 OS 最长。
