HER2阳性转移性乳腺癌患者在治疗过程中发生脑转移的结局及预后因素

Outcomes and Prognostic Factors in HER2-Positive Metastatic Breast Cancer Patients Who Had Developed Brain Metastasis in the Treatment Process.

作者信息

Dogan Izzet, Kizildag Inci, Özkurt Selnur, Ibis Kamuran, Vatansever Sezai, Saip Pinar, Aydiner Adnan

机构信息

Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey.

Breast Radiology, Istanbul University Institute of Oncology, Istanbul, Turkey.

出版信息

Oncology. 2023;101(4):262-269. doi: 10.1159/000529030. Epub 2023 Feb 21.

DOI:10.1159/000529030

PMID:36809751

Abstract

INTRODUCTION

Patients with HER2-positive metastatic breast cancer are at risk for developing brain metastases. Different anti-HER2 treatments can be used in the management of the disease. In this study, we aimed to evaluate the prognosis and the factors affecting the prognosis in brain metastatic patients with HER2-positive breast cancer.

METHODS

Clinical and pathological features of HER2-positive metastatic breast cancer patients and magnetic resonance imaging features at the onset of brain metastasis were recorded. Survival analyses were performed using Kaplan-Meier and Cox regression methods.

RESULTS

Analyses of the study were performed by including 83 patients. The median age was 49 (25-76). All patients had HER2 receptor-positive tumors. Thirty-five (42.2%) patients had a hormone-positive disease. Thirty-two (38.6%) patients had de novo metastatic disease. Brain metastasis sites were found to be bilateral - 49.4%, right brain - 21.7%, left brain - 12%, and unknown - 16.9%, respectively. The median brain metastasis largest size was 16 mm (range 5-63). The median follow-up time from the post-metastasis period was 36 months. Median overall survival (OS) was found as 34.9 months (95% CI, 24.6-45.2). In multivariate analysis for factors affecting OS, estrogen receptor status (p = 0.025), number of chemotherapy agents used with trastuzumab (p = 0.010), number of HER2-based therapy (p = 0.010), and the largest size of brain metastasis (p = 0.012) were found to be statistically significant.

CONCLUSIONS

In this study, we demonstrated the prognosis in brain metastatic patients with HER2-positive breast cancer. When the factors affecting the prognosis were evaluated, we determined that the largest size of brain metastasis, estrogen receptor positivity, and the use of TDM-1 and lapatinib plus capecitabine consecutively during the treatment process affected the prognosis of the disease.

摘要

引言

HER2阳性转移性乳腺癌患者有发生脑转移的风险。不同的抗HER2治疗可用于该疾病的管理。在本研究中，我们旨在评估HER2阳性乳腺癌脑转移患者的预后及影响预后的因素。

方法

记录HER2阳性转移性乳腺癌患者的临床和病理特征以及脑转移发生时的磁共振成像特征。使用Kaplan-Meier法和Cox回归方法进行生存分析。

结果

对83例患者进行了研究分析。中位年龄为49岁（25 - 76岁）。所有患者的肿瘤HER2受体均为阳性。35例（42.2%）患者患有激素阳性疾病。32例（38.6%）患者为初发转移性疾病。发现脑转移部位双侧占49.4%，右脑占21.7%，左脑占12%，不明占16.9%。脑转移最大直径的中位数为16 mm（范围5 - 63）。转移后时期的中位随访时间为36个月。中位总生存期（OS）为34.9个月（95%CI，24.6 - 45.2）。在影响OS的多因素分析中，发现雌激素受体状态（p = 0.025）、与曲妥珠单抗联合使用的化疗药物数量（p = 0.010）、基于HER2的治疗次数（p = 0.010）以及脑转移最大直径（p = 0.012）具有统计学意义。