Schick Alex, Hardy Sara, Strawderman Myla, Zheng Dandan, Cummings Michael, Milano Michael T, Magnuson Allison, Behr Jacqueline, Sammons Sarah, Usuki Kenneth, Mohile Nimish, O'Regan Ruth, Anders Carey K, Hicks David, Dhakal Ajay
Division of Hematology/Oncology, Department of Medicine & Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
NPJ Breast Cancer. 2024 Aug 2;10(1):69. doi: 10.1038/s41523-024-00673-z.
The objective of the study is to assess impact of systemic disease (SD) status on overall survival and brain metastasis (BM) control, adopting a novel landmark approach to categorize SD among breast cancer (BC) patients. This single institution retrospective study included BCBM patients who have received stereotactic radiosurgery (SRS) to brain. Separate endpoints [CNS failure-free survival (cFFS), overall survival (OS)] were analyzed from each Landmark (LM): LM1 (3-months), LM2 (6-months). Patients were categorized into early and non-early progression (EP, NEP) groups depending on SD status before LMs. Median survivals from LM were assessed with Kaplan Meier plots, compared with Log-Rank test. EP was associated with worse median cFFS and OS vs NEP in both LM analyses (cFFS- LM1: 3.6 vs. 9.7 months, p = 0.0016; LM2: 2.3 vs. 12.5 months, p < 0.0001; OS- LM1: 3.6 vs. 24.3 months, p < 0.0001; LM2: 5.3 vs. 30.2 months, p < 0.0001). In multivariate analyses, EP was associated with shorter cFFS [LM1: Hazard Ratio (HR) with 95% confidence interval (CI) 3.16, 1.46-6.83, p = 0.0034; LM2: 5.32, 2.33-12.15, p = <0.0001] and shorter OS (LM1: HR with 95% CI 4.28, 1.98-9.12, p = 0.0002; LM2: 7.40, 3.10-17.63, p = <0.0001) vs NEP. Early systemic disease progressions after 1st SRS to brain is associated with worse cFFS and OS in patients with BCBM.
本研究的目的是采用一种新颖的标志性方法对乳腺癌（BC）患者的全身疾病（SD）状态进行分类，以评估全身疾病状态对总生存期和脑转移（BM）控制的影响。这项单机构回顾性研究纳入了接受脑部立体定向放射外科治疗（SRS）的BCBM患者。从每个标志性时间点（LM）分析了不同的终点指标[无中枢神经系统衰竭生存期（cFFS）、总生存期（OS）]：标志性时间点1（3个月）、标志性时间点2（6个月）。根据标志性时间点之前的SD状态，将患者分为早期进展组和非早期进展组（EP，NEP）。使用Kaplan-Meier曲线评估从标志性时间点开始的中位生存期，并通过对数秩检验进行比较。在两个标志性时间点分析中，与NEP相比，EP的中位cFFS和OS均较差（cFFS - 标志性时间点1：3.6个月对9.7个月，p = 0.0016；标志性时间点2：2.3个月对12.5个月，p < 0.0001；OS - 标志性时间点1：3.6个月对24.3个月，p < 0.0001；标志性时间点2：5.3个月对30.2个月，p < 0.0001）。在多变量分析中，与NEP相比，EP与较短的cFFS相关[标志性时间点1：风险比（HR）及95%置信区间（CI）为3.16，1.46 - 6.83，p = 0.0034；标志性时间点2：5.32，2.33 - 12.15，p = <0.0001]，且OS较短（标志性时间点1：HR及95%CI为4.28，1.98 - 9.12，p = 0.0002；标志性时间点2：7.40，3.10 - 17.63，p = <0.0001）。首次脑部SRS后早期全身疾病进展与BCBM患者较差的cFFS和OS相关。
