Shantou University Medical College, Shantou, China.
Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Cancer Med. 2023 Mar;12(6):6547-6557. doi: 10.1002/cam4.5425. Epub 2022 Nov 9.
Early detection of brain metastasis (BM) is essential for prognostic improvement in breast cancer (BC) patients. The aim was to identify predictors of BCBM in different molecular subtypes on a population-based level.
The Surveillance, Epidemiology, and End Results database was used to select BC patients diagnosed from 2010 to 2018. We evaluated the incidence and risk factors of BCBM and tested the interaction effects between molecular subtypes and other risk factors.
Among the 527,525 selected patients, molecular subtypes significantly interacted with T stage and extracranial metastasis (ECM) patterns on the risk of BM in the whole BC population (interaction p = 0.002, <0.001, respectively) and after excluding patients with unknown states of key factors. BM development was independent of the T stage only in HR-/HER2- patients (trend p = 0.126). We selected BC patients with single-organ ECM and found a significant interaction between molecular subtypes and ECM patterns (interaction p = 0.013). The impact of ECM patterns on the risk of BM was limited to HR-/HER2- patients (trend p < 0.001), for whom using bone metastasis as a reference, lung metastasis increased the risk of BM (OR = 1.936, 95% CI: 1.300-2.882, p = 0.001).
T stage and ECM patterns had different associations with BM in different molecular subtypes. HR-/HER2- BC had distinct features on BM development, manifested as a lack of tumor size effect and is associated with lung metastasis. Close surveillance for BM should be considered for HR-/HER2- BC patients.
早期发现脑转移（BM）对于改善乳腺癌（BC）患者的预后至关重要。本研究旨在基于人群水平，确定不同分子亚型 BC 患者发生 BM 的预测因素。
利用监测、流行病学和最终结果数据库，选择 2010 年至 2018 年期间诊断的 BC 患者。我们评估了 BCBM 的发生率和风险因素，并检验了分子亚型与其他风险因素之间的交互作用。
在纳入的 527525 例患者中，分子亚型与 T 分期和颅外转移（ECM）模式在整个 BC 人群（交互 p = 0.002，<0.001）和排除关键因素未知状态的患者后，对 BM 风险的交互作用有显著意义。仅在 HR-/HER2- 患者中，BM 的发生与 T 分期无关（趋势 p = 0.126）。我们选择了 ECM 模式为单一器官转移的 BC 患者，发现分子亚型与 ECM 模式之间存在显著的交互作用（交互 p = 0.013）。ECM 模式对 BM 风险的影响仅限于 HR-/HER2- 患者（趋势 p<0.001），对于这些患者，以骨转移为参考，肺转移增加了 BM 的风险（OR = 1.936，95%CI：1.300-2.882，p = 0.001）。
T 分期和 ECM 模式在不同分子亚型中与 BM 的关系不同。HR-/HER2- BC 在 BM 发展方面具有独特的特征，表现为缺乏肿瘤大小效应，与肺转移有关。对于 HR-/HER2- BC 患者，应密切监测 BM。
