Niraula Sujan, Gouli Sugam, Baran Andrea M, O'Regan Ruth, Tyburski Haley, Zhang Huina, Hardy Sara, Mohile Nimish, Anders Carey K, Dhakal Ajay
Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, NY.
Rochester General Hospital, Rochester, NY.
Clin Breast Cancer. 2025 Jan;25(1):65-74.e5. doi: 10.1016/j.clbc.2024.09.019. Epub 2024 Oct 5.
It is unclear whether breast cancer (BC) subtypes or CSF cytology results are associated with overall survival (OS) among patients with BC leptomeningeal disease (LMD). This single-institution retrospective study compares OS among BC patients with LMD across various breast cancer subtypes and CSF cytology results.
The study enrolled BC patients diagnosed with LMD between 2010 and 2023. Breast cancer subtypes were classified as A. ER+/HER2-, HER2+, or triple-negative BC (TNBC); B. HER2+, HER2-Low, HER2-Zero. CSF cytology subtypes included CSF+, CSF-, or CSF not tested (NT). OS was summarized via Kaplan-Meier analysis and compared using log-rank test. Cox models were used for multivariate analyses.
Out of 69 patients registered, median OS (95% CI) for ER+/HER2- (n = 33), HER2+ (n = 12) and TNBC (n = 24) subtypes were 8.0 (3.02, 24.8), 5.71 (1.61, not estimated) and 3.2 (1.11, 4.95) months (P = .17). In multivariate analysis, TNBC was associated with worse OS versus ER+/HER2- [Hazard Ratio (HR), 95% CI: 2.64, 1.23-5.80, P = .04]. HER2 subtypes (HER2-Zero, n = 21; HER2-Low, n = 32; HER2+, n = 12) showed no significant differences in OS. Median OS (95% CI) for CSF+ (n = 16), CSF- (n = 18), and CSF NT (n = 35) groups were 3.54 (1.61, 12.72), 13.41 (4.95, 61.93) and 3.28 (1.44, 6.92) months (P = .04). Multivariate analysis showed both CSF+ and CSF NT were associated with shorter OS compared to CSF- group [HR (95% CI) 4.50 (1.75, 12.11) for CSF+ vs. CSF-; 2.91 (1.45, 6.26) for CSF NT vs. CSF-; P = .002].
TNBC LMD group was associated with worse OS than ER+/HER2- BC LMD when adjusting for other prognostic factors. CSF- LMD patients had better OS than CSF+ or CSF NT LMD.
目前尚不清楚乳腺癌（BC）亚型或脑脊液细胞学检查结果是否与BC软脑膜转移（LMD）患者的总生存期（OS）相关。这项单机构回顾性研究比较了不同乳腺癌亚型和脑脊液细胞学检查结果的BC-LMD患者的OS。
该研究纳入了2010年至2023年间被诊断为LMD的BC患者。乳腺癌亚型分为：A.雌激素受体阳性/人表皮生长因子受体2阴性（ER+/HER2-）、HER2阳性或三阴性乳腺癌（TNBC）；B.HER2阳性、HER2低表达、HER2零表达。脑脊液细胞学亚型包括脑脊液阳性（CSF+）、脑脊液阴性（CSF-）或未检测脑脊液（NT）。通过Kaplan-Meier分析总结OS，并使用对数秩检验进行比较。采用Cox模型进行多变量分析。
在登记的69例患者中，ER+/HER2-亚型（n = 33）、HER2阳性亚型（n = 12）和TNBC亚型（n = 24）的中位OS（95%CI）分别为8.0（3.02，24.8）、5.71（1.61，未估计）和3.2（1.11，4.95）个月（P = 0.17）。在多变量分析中，与ER+/HER2-亚型相比，TNBC与较差的OS相关[风险比（HR），95%CI：2.64，1.23 - 5.80，P = 0.04]。HER2亚型（HER2零表达，n = 21；HER2低表达，n = 32；HER2阳性，n = 12）在OS方面无显著差异。CSF+组（n = 16）、CSF-组（n = 18）和脑脊液未检测组（n = 35）的中位OS（95%CI）分别为3.54（1.61，12.72）、13.41（4.95，61.93）和3.28（1.44，6.92）个月（P = 0.04）。多变量分析显示，与CSF-组相比，CSF+组和脑脊液未检测组均与较短的OS相关[CSF+组与CSF-组相比，HR（95%CI）为4.50（1.75，12.11）；脑脊液未检测组与CSF-组相比，HR（95%CI）为2.91（1.45，6.26）；P = 0.002]。
在调整其他预后因素后，TNBC-LMD组的OS比ER+/HER2-BC-LMD组更差。CSF-LMD患者的OS优于CSF+或脑脊液未检测的LMD患者。
