法国 ESME 队列中 HER2 低转移性乳腺癌脑和/或软脑膜转移的发生率和结局。

Incidence and outcome of brain and/or leptomeningeal metastases in HER2-low metastatic breast cancer in the French ESME cohort.

机构信息

Department of Medical Oncology, Gustave Roussy, Villejuif.

Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT Oncopole, Toulouse.

出版信息

ESMO Open. 2024 May;9(5):103447. doi: 10.1016/j.esmoop.2024.103447. Epub 2024 May 3.

DOI:10.1016/j.esmoop.2024.103447

PMID:38703431

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11087908/

Abstract

BACKGROUND

Breast cancer (BC) is the second most common cancer that metastasizes to the brain. Particularly up to half of patients with human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (mBC) may develop brain metastases over the course of the disease. Nevertheless, little is known about the prevalence and the outcome of brain and leptomeningeal metastases (BLMM) in HER2-low BC. We compared the cumulative incidence of BLMM and associated outcomes among patients with HER2-low, HER2-negative (HER2-) and HER2+ mBC.

PATIENTS AND METHODS

This cohort study was conducted from the Epidemiological Strategy and Medical Economics (ESME) mBC database and included patients treated for mBC between 2012 and 2020 across 18 French comprehensive cancer centers and with known HER2 and hormone receptor (HR) status. The cumulative incidence of BLMM after metastatic diagnosis was estimated using a competing risk methodology with death defined as a competing event.

RESULTS

19 585 patients were included with 6118 (31.2%), 9943 (50.8%) and 3524 (18.0%) being HER2-low, HER2- and HER2+ mBC, respectively. After a median follow-up of 48.6 months [95% confidence interval (CI) 47.7-49.3 months], BLMM were reported in 4727 patients: 1192 (25.2%) were diagnosed with BLMM at first metastatic diagnosis and 3535 (74.8%) after metastatic diagnosis. Multivariable analysis adjusted for age, histological grade, metastases-free interval and HR status showed that the risk of BLMM at metastatic diagnosis was similar in patients with HER2- compared to HER2-low mBC [odds ratio (OR) (95% CI) 1.00 (0.86-1.17)] and higher in those with HER2+ compared to HER2-low [OR (95% CI) 2.23 (1.87-2.66)]. Similar results were found after metastatic diagnosis; the risk of BLMM was similar in HER2- compared to HER2-low [subdistribution hazard ratio (sHR) (95% CI) 1.07 (0.98-1.16)] and higher in the HER2+ group [sHR (95% CI) 1.56 (1.41-1.73)].

CONCLUSIONS

The prevalence and evolution of BLMM in HER2-low mBC are similar to those in patients with HER2- tumors. In contrast to patients with HER2+ mBC, the prognosis of BLMM remains dismal in this population.

摘要

背景

乳腺癌（BC）是第二大转移到大脑的常见癌症。特别是，多达一半的人表皮生长因子受体 2（HER2）阳性（HER2+）转移性乳腺癌（mBC）患者可能会在疾病过程中发展为脑转移。然而，对于 HER2 低水平的乳腺癌中脑和软脑膜转移（BLMM）的患病率和结局知之甚少。我们比较了 HER2 低水平、HER2 阴性（HER2-）和 HER2+ mBC 患者中 BLMM 的累积发生率和相关结局。

患者和方法

这项队列研究来自于流行病学策略和医学经济学（ESME）mBC 数据库，纳入了 2012 年至 2020 年期间在法国 18 家综合癌症中心接受 mBC 治疗且已知 HER2 和激素受体（HR）状态的患者。使用竞争风险方法估计转移性诊断后 BLMM 的累积发生率，以死亡为竞争事件。

结果

纳入了 19585 名患者，其中 6118 名（31.2%）、9943 名（50.8%）和 3524 名（18.0%）分别为 HER2 低水平、HER2-和 HER2+ mBC。中位随访 48.6 个月[95%置信区间（CI）47.7-49.3 个月]后，4727 名患者诊断为 BLMM：1192 名（25.2%）在首次转移性诊断时诊断为 BLMM，3535 名（74.8%）在转移性诊断后诊断为 BLMM。多变量分析调整了年龄、组织学分级、无转移间隔和 HR 状态，结果显示，与 HER2-低水平 mBC 相比，HER2-患者在转移性诊断时发生 BLMM 的风险相似[比值比（OR）（95%CI）1.00（0.86-1.17）]，而与 HER2-低水平 mBC 相比，HER2+患者的风险更高[OR（95%CI）2.23（1.87-2.66）]。在转移性诊断后也得到了相似的结果；与 HER2-低水平 mBC 相比，HER2-患者发生 BLMM 的风险相似[亚分布风险比（sHR）（95%CI）1.07（0.98-1.16）]，而 HER2+组的风险更高[sHR（95%CI）1.56（1.41-1.73）]。