Cai Shuang-Long, Wang Zhi-Hong, Chen Xiao-Geng, Han Lei, Gong Guo-Xian, Chen Yan-Ping, Lin Xiu-Quan, Ma Tao, Chen Hong-Dan
Department of Oncological Surgery, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
Department of Hematology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
Front Oncol. 2022 Jun 27;12:905065. doi: 10.3389/fonc.2022.905065. eCollection 2022.
Brain metastasis (BM) frequently occurs in HER2-positive breast cancer (BC) patients, but the risk factors of BM in this type of patients are still unknown. Our study aims to assess the risk factors of BM and prognostic analysis in HER2-positive BC patients.
Univariate analysis used -test, chi-square test, and Fisher's exact test to find out the risk factors for BM, and multivariable analysis was done with stepwise logistic regression analysis. Prognostic data analysis was estimated by the Kaplan-Meier method.
A total of 228 HER2-positive BC patients were included, of whom 214 patients were postoperative metastatic patients and 14 patients were stage IV patients. Through comparing the stratified variables between 51 postoperative metastatic patients with BM and 163 postoperative metastatic patients without BM, the multivariate analysis showed that age ≤40 years (OR 2.321, 95% CI: 1.089 to 4.948) and first metastatic site with lung metastasis (OR 2.168, 95% CI: 1.099 to 4.274) were independent risk factors for BM in HER2-positive BC patients. Prognostic data of all 65 HER2-positive BC patients with BM showed that the time from the diagnosis of BC to the development of breast cancer brain metastasis (BCBM) was 36.3 months (95% CI: 30.0 to 42.1 months). The time from the diagnosis of first recurrence and metastasis stage to the diagnosis of BCBM was 11.35 months (95% CI: 7.1 to 18.4 months). The time from the diagnosis of BCBM to the time of follow-up was 24.1 months (95% CI: 13.9 to 37.5 months). Up until the time of follow-up data, a total of 38 patients had died, and the time from the diagnosis of BM of these 38 patients to death was 11.0 months (95% CI: 9.0 to 20.4 months).
The prognosis of HER2-positive BC patients with BM was poor due to the lack of effective treatments for BM. Age ≤40 years and first metastatic site with lung metastasis were the independent risk factors for BM in HER2-positive BC patients. Future research about pre-emptive medical interventions may help to improve the prognosis of HER2-positive BC patients with high risk to develop BM.
脑转移（BM）在人表皮生长因子受体2（HER2）阳性乳腺癌（BC）患者中频繁发生，但此类患者发生脑转移的危险因素仍不清楚。我们的研究旨在评估HER2阳性BC患者发生脑转移的危险因素并进行预后分析。
单因素分析采用t检验、卡方检验和Fisher精确检验以找出发生脑转移的危险因素，多因素分析采用逐步逻辑回归分析。预后数据分析采用Kaplan-Meier法进行估计。
共纳入228例HER2阳性BC患者，其中214例为术后转移患者，14例为IV期患者。通过比较51例发生脑转移的术后转移患者和163例未发生脑转移的术后转移患者之间的分层变量，多因素分析显示年龄≤40岁（比值比[OR]2.321，95%置信区间[CI]：1.089至4.948）和首个转移部位为肺转移（OR 2.168，95%CI：1.099至4.274）是HER2阳性BC患者发生脑转移的独立危险因素。所有65例发生脑转移的HER2阳性BC患者的预后数据显示，从BC诊断到发生乳腺癌脑转移（BCBM）的时间为36.3个月（95%CI：30.0至42.1个月）。从首次复发和转移阶段诊断到BCBM诊断的时间为11.35个月（95%CI：7.1至18.4个月）。从BCBM诊断到随访的时间为24.1个月（95%CI：13.9至37.5个月）。截至随访数据时，共有38例患者死亡，这38例患者从BM诊断到死亡的时间为11.0个月（95%CI：9.0至20.4个月）。
由于缺乏针对脑转移的有效治疗方法，HER2阳性BC发生脑转移患者的预后较差。年龄≤40岁和首个转移部位为肺转移是HER2阳性BC患者发生脑转移的独立危险因素。未来关于预防性医学干预的研究可能有助于改善有发生脑转移高风险的HER2阳性BC患者的预后。
