Department of Hematology and Oncology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Center for Clinical Research, Cleveland Clinic Foundation, Weston, FL, 33331, USA.
Breast Cancer Res Treat. 2024 Aug;206(3):527-541. doi: 10.1007/s10549-024-07321-x. Epub 2024 Apr 29.
Patients with Breast Cancer (BC) with Brain Metastasis (BCBM) have poor survival outcomes. We aimed to explore the clinico-pathologic and therapeutic factors predicting the survival in patients with de novo BCBM using the National Cancer Database (NCDB).
The NCDB was queried for patients with BC between 2010 and 2020. Survival analysis with Kaplan-Meier curves and log rank tests were used to find median overall survival (OS) in months (95% CI) across the different variables. A multivariate cox regression model was computed to identify significant predictors of survival.
Out of n = 2,610,598 patients, n = 9005 (0.34%) had de novo BCBM. A trend of decreasing OS was observed with increasing age, Charlson-Deyo score (CDS), and number of extracranial metastatic sites. The highest median OS was observed in the Triple Positive and the lowest OS in the Triple Negative subgroup. Based on treatment regimen, combination of systemic therapy and local therapy achieved the highest OS. A positive trend in OS was observed in the BC subgroup analysis with targeted therapy demonstrating a survival benefit when added to systemic therapy. The multivariate cox regression model showed that age, race, ethnicity, insurance, median income, facility type, CDS, BC subtype, metastatic location sites, and treatment combinations received were significantly associated with risk of death. Receiving only local treatment for BM without systemic therapy more than doubled the risk of death compared to combining it with systemic therapy.
This analysis suggests that treatment of systemic disease is the major factor influencing survival in patients with BCBM. Moreover, targeted therapy with anti-HER2 increased survival when added to systemic therapy explaining the highest median OS noted in the Triple Positive subgroup.
患有乳腺癌脑转移（BCBM）的患者生存预后较差。本研究旨在利用国家癌症数据库（NCDB）探讨预测初发 BCBM 患者生存的临床病理和治疗因素。
NCDB 中检索了 2010 年至 2020 年期间患有乳腺癌的患者。采用 Kaplan-Meier 曲线和对数秩检验进行生存分析，以确定不同变量下的中位总生存期（OS）（95%CI）。采用多变量 Cox 回归模型来确定生存的显著预测因素。
在 n = 2,610,598 例患者中，n = 9005（0.34%）患有初发 BCBM。OS 呈随年龄、Charlson-Deyo 评分（CDS）和颅外转移部位数量增加而降低的趋势。三阳性亚组的中位 OS 最高，三阴性亚组的 OS 最低。根据治疗方案，全身治疗联合局部治疗的效果最佳。在乳腺癌亚组分析中，靶向治疗联合全身治疗显示出生存获益，OS 呈上升趋势。多变量 Cox 回归模型显示，年龄、种族、民族、保险、中位收入、医疗机构类型、CDS、乳腺癌亚型、转移部位和治疗方案的选择与死亡风险显著相关。与全身治疗联合局部治疗相比，仅对 BM 进行局部治疗而不进行全身治疗，死亡风险增加了一倍以上。
本分析表明，治疗系统性疾病是影响 BCBM 患者生存的主要因素。此外，当与全身治疗联合应用时，抗 HER2 的靶向治疗可提高生存，这解释了在三阳性亚组中观察到的最高中位 OS。
