Id Said Badr, Soliman Hany, Moravan Veronika, Myrehaug Sten, Tseng Chia-Lin, Detsky Jay, Sahgal Arjun, Warner Ellen, Jerzak Katarzyna J
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada.
Applied Statistician, VM Stats, Toronto, ON, Canada.
J Neurooncol. 2023 Sep;164(2):437-445. doi: 10.1007/s11060-023-04421-4. Epub 2023 Aug 27.
We characterized the risk factors and survival of metastatic breast cancer (MBC) patients with brain metastases (BrM) as the first and only site of disease in a large, retrospective cohort.
MBC patients treated for BrM with radiation at a quaternary institution between 2005 and 2019 were identified. MBC patients with BrM but without concurrent extracranial metastases (ECM) or leptomeningeal disease (LMD) were classified as brain-only. Factors associated with brain-only MBC, brain-specific progression free survival (bsPFS) and overall survival (OS) were investigated.
A total of 691 patients with MBC and BrM were analyzed. Among them, 67 patients (9.7%, n = 67/691) presented with brain-only MBC without concurrent ECM/LMD. Within this subgroup, 40 patients (5.8%, n = 40/691) remained free of any ECM or LMD, while 17 patients (2.5%) developed LMD, and 10 patients (1.4%%) developed ECM with a median follow-up of 8 months (IQR 2-35). Patients with brain-only MBC were more likely to have a single BrM [OR 3.41 (1.62-7.19), p = 0.001] and either HER2+ [OR 3.3 (1.13-9.65), p = 0.03] or TNBC [OR 4.09 (1.42-11.74), p = 0.009] subtypes. Patients who presented with brain-only MBC also had significantly longer OS [HR 0.45, (0.22-0.86), p = 0.008] and a trend toward longer bsPFS [HR 0.67 (0.44-1.03), p = 0.05] compared to those with concurrent ECM/LMD.
Patients with brain-only MBC had a longer bsPFS and OS than those with ECM. Patients with HER2+ and TNBC were more likely to have brain-only disease compared to those with HR+/HER2- MBC.
我们在一个大型回顾性队列中，对以脑转移（BrM）作为疾病的首个也是唯一部位的转移性乳腺癌（MBC）患者的危险因素和生存率进行了特征分析。
确定了2005年至2019年间在一家四级医疗机构接受放疗的BrM的MBC患者。BrM但无并发颅外转移（ECM）或软脑膜疾病（LMD）的MBC患者被归类为仅脑转移。研究了与仅脑转移MBC、脑特异性无进展生存期（bsPFS）和总生存期（OS）相关的因素。
共分析了691例MBC和BrM患者。其中，67例患者（9.7%，n = 67/691）表现为仅脑转移的MBC，无并发ECM/LMD。在这个亚组中，40例患者（5.8%，n = 40/691）未出现任何ECM或LMD，17例患者（2.5%）发生LMD，10例患者（1.4%）发生ECM，中位随访时间为8个月（IQR 2 - 35）。仅脑转移的MBC患者更有可能有单个BrM [OR 3.41（1.62 - 7.19），p = 0.001]以及HER2 + [OR 3.3（1.13 - 9.65），p = 0.03]或三阴性乳腺癌（TNBC）[OR 4.09（1.42 - 11.74），p = 0.009]亚型。与并发ECM/LMD的患者相比，仅脑转移的MBC患者的OS也显著更长[HR 0.45，（0.22 - 0.86），p = 0.008]，并且bsPFS有延长趋势[HR 0.67（0.44 - 1.03），p = 0.05]。
仅脑转移的MBC患者的bsPFS和OS比有ECM的患者更长。与HR + /HER2 - MBC患者相比，HER2 + 和TNBC患者更有可能仅发生脑转移。
