Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Department of Neurosurgery, Cantonal Hospital St, Gallen, St. Gallen, Switzerland.
J Neurooncol. 2024 Sep;169(2):379-390. doi: 10.1007/s11060-024-04728-w. Epub 2024 Jun 3.
Advancements in metastatic breast cancer (BC) treatment have enhanced overall survival (OS), leading to increased rates of brain metastases (BM). This study analyzes the association between microsurgical tumor reduction and OS in patients with BCBM, considering tumor molecular subtypes and perioperative treatment approaches.
Retrospective analysis of surgically treated patients with BCBM from two tertiary brain tumor Swiss centers. The association of extent of resection (EOR), gross-total resection (GTR) achievement, and postoperative residual tumor volume (RV) with OS and intracranial progression-free survival (IC-PFS) was evaluated using Cox proportional hazard model.
101 patients were included in the final analysis, most patients (38%) exhibited HER2-/HR + BC molecular subtype, followed by HER2 + /HR + (25%), HER2-/HR- (21%), and HER2 + /HR- subtypes (13%). The majority received postoperative systemic treatment (75%) and radiotherapy (84%). Median OS and intracranial PFS were 22 and 8 months, respectively. The mean pre-surgery intracranial tumor volume was 26 cm, reduced to 3 cm post-surgery. EOR, GTR achievement and RV were not significantly associated with OS or IC-PFS, but higher EOR and lower RV correlated with extended OS in patients without extracranial metastases. HER2-positive tumor status was associated with longer OS, extracranial metastases at BM diagnosis and symptomatic lesions with shorter OS and IC-PFS.
Our study found that BC molecular subtypes, extracranial disease status, and BM-related symptoms were associated with OS in surgically treated patients with BCBM. Additionally, while extensive resection to minimize residual tumor volume did not significantly affect OS across the entire cohort, it appeared beneficial for patients without extracranial metastases.
转移性乳腺癌（BC）治疗的进展提高了总生存率（OS），导致脑转移（BM）的发生率增加。本研究分析了考虑肿瘤分子亚型和围手术期治疗方法的情况下，BCBM 患者的肿瘤缩小与 OS 的关系。
回顾性分析了来自瑞士两个三级脑肿瘤中心的接受手术治疗的 BCBM 患者。使用 Cox 比例风险模型评估了切除范围（EOR）、大体全切除（GTR）的实现以及术后残余肿瘤体积（RV）与 OS 和颅内无进展生存期（IC-PFS）的关系。
最终分析纳入 101 例患者，大多数患者（38%）表现出 HER2-/HR+BC 分子亚型，其次是 HER2+/HR+（25%）、HER2-/HR-（21%）和 HER2+/HR- 亚型（13%）。大多数患者接受了术后全身治疗（75%）和放疗（84%）。中位 OS 和颅内 PFS 分别为 22 个月和 8 个月。术前颅内肿瘤体积平均为 26cm3，术后缩小至 3cm3。EOR、GTR 实现和 RV 与 OS 或 IC-PFS 无显著相关性，但在无颅外转移的患者中，EOR 较高和 RV 较低与延长 OS 相关。HER2 阳性肿瘤状态与 OS 延长相关，BM 诊断时存在颅外转移和症状性病变与 OS 和 IC-PFS 缩短相关。
我们的研究发现，BC 分子亚型、颅外疾病状态和 BM 相关症状与接受手术治疗的 BCBM 患者的 OS 相关。此外，尽管广泛切除以最大限度减少残余肿瘤体积在整个队列中并未显著影响 OS，但对于无颅外转移的患者似乎有益。
