乳腺癌脑转移患者颅内和颅外转移灶有限时预后良好。
Favorable prognosis of breast cancer brain metastases patients with limited intracranial and extracranial metastatic lesions.
机构信息
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
出版信息
Radiat Oncol. 2023 Jul 1;18(1):107. doi: 10.1186/s13014-023-02293-6.
BACKGROUND
Breast cancer brain metastases (BCBM) are highly heterogenous with widely differing survival. The prognosis of the oligometastatic breast cancer (BC) patients with brain metastases (BM) has not been well studied. We aimed to investigate the prognosis of BCBM patients with limited intracranial and extracranial metastatic lesions.
METHODS
Four hundred and forty-five BCBM patients treated between 1st January 2008 and 31st December 2018 at our institute were included. Clinical characteristics and treatment information were obtained from patient's medical records. The updated breast Graded Prognostic Assessment (Breast GPA) was calculated.
RESULTS
The median OS after diagnosis of BM were 15.9 months. Median OS for patients with GPA 0-1.0, 1.5-2, 2.5-3 and 3.5-4 were 6.9, 14.2, 21.8, 42.6 months respectively. The total number of intracranial and extracranial metastatic lesions, in addition to the Breast GPA, salvage local therapy and systemic therapy (anti-HER2 therapy, chemotherapy and endocrine therapy) were demonstrated to be associated with prognosis. One hundred and thirteen patients (25.4%) had 1-5 total metastatic lesions at BM diagnosis. Patients with 1-5 total metastatic lesions had a significantly longer median OS of 24.3 months compared to those with greater than 5 total metastatic lesions with a median OS of 12.2 months (P < 0.001; multivariate HR 0.55, 95% CI, 0.43-0.72). Among the patients with 1-5 metastatic lesions, median OS for GPA 0-1.0 was 9.8 months, compared to 22.8, 28.8 and 71.0 for GPA 1.5-2.0, 2.5-3.0 and 3.5-4.0 respectively, which is much longer than the corresponding patients with greater than 5 total metastatic lesions, with medium OS of 6.8, 11.6, 18.6 and 42.6 months respectively for GPA 0-1.0, 1.5-2.0, 2.5-3.0 and 3.5-4.0.
CONCLUSIONS
The patients with 1-5 total metastatic lesions demonstrated better OS. The prognostic value of the Breast GPA and the survival benefit of salvage local therapy and continuation of systemic therapy after BM were confirmed.
背景
乳腺癌脑转移（BCBM）具有高度异质性，生存时间差异很大。脑转移（BM）寡转移乳腺癌（BC）患者的预后尚未得到很好的研究。我们旨在研究颅内和颅外转移性病变有限的 BCBM 患者的预后。
方法
纳入了 2008 年 1 月 1 日至 2018 年 12 月 31 日在我院接受治疗的 445 例 BCBM 患者。从患者病历中获取临床特征和治疗信息。计算更新的乳腺分级预后评估（Breast GPA）。
结果
BM 诊断后中位 OS 为 15.9 个月。GPA0-1.0、1.5-2、2.5-3 和 3.5-4 的患者中位 OS 分别为 6.9、14.2、21.8 和 42.6 个月。颅内和颅外转移病灶总数，除了 Breast GPA 外，挽救性局部治疗和全身治疗（抗 HER2 治疗、化疗和内分泌治疗）均与预后相关。113 例患者（25.4%）在 BM 诊断时具有 1-5 个总转移病灶。与转移病灶大于 5 个的患者相比，转移病灶为 1-5 个的患者中位 OS 显著延长（24.3 个月），而转移病灶大于 5 个的患者中位 OS 为 12.2 个月（P<0.001；多变量 HR0.55，95%CI，0.43-0.72）。在具有 1-5 个转移病灶的患者中，GPA0-1.0 的中位 OS 为 9.8 个月，而 GPA1.5-2.0、2.5-3.0 和 3.5-4.0 的中位 OS 分别为 22.8、28.8 和 71.0，明显长于相应的转移病灶大于 5 个的患者，中位 OS 分别为 6.8、11.6、18.6 和 42.6 个月，GPA0-1.0、1.5-2.0、2.5-3.0 和 3.5-4.0。
结论
具有 1-5 个总转移病灶的患者表现出更好的 OS。证实了乳腺 GPA 的预后价值以及 BM 后挽救性局部治疗和全身治疗的生存获益。
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