CAJ | 학술논문

背景与目的:脑是乳腺癌常见转移部位之一,乳腺癌脑转移发生率在10%～15%,伴脑转移的乳腺癌患者预后较差.本研究目的在于分析4种不同亚型乳腺癌脑转移患者的临床特征及预后因素.方法:回顾分析1997年10月至2008年7月中山大学肿瘤防治中心收治的89例脑转移患者的资料,包括导管A型30例,导管B型20例,HER-2型16例,三阴型14例,另9例免疫组化结果不详.分析4种乳腺癌脑转移患者初诊时的临床病理特征、复发特点、影响复发后患者预后的因素等,并进一步对导管型乳腺癌患者的内分泌治疗进行研究.结果:全组患者中位年龄46岁(28～74岁),出现脑转移的时间与初诊时的病理分期密切相关,Ⅰ期患者最长(P<0.001).中位随访时间41.0个月(6.0～141.0个月),全组中位生存时间8.0个月(0～80.0个月),1年生存率32.0%,5年生存率4.0%.多因素分析显示,PS评分大于1分、多发转移灶、未进行全脑放疗联合化疗均是不良预后因素.与导管A型乳腺癌相比,HER-2型和三阴型乳腺癌脑转移具有发生时间早、一线治疗后进展快(8.0个月 vs.11.0个月)、总生存期短(25.0个月vs.63.0个月)等特点,导管A型具有进展缓慢、预后好的倾向,他莫昔芬能改善导管A型和导管B型患者的生存(中位生存时间24.0个月vs.7.0个月,P=0.002).结论:乳腺癌脑转移生存期较短,其中HER-2型和三阴型预后更差.治疗以全脑放疗联合化疗为主.导管型患者接受他莫昔芬治疗有生存获益.
배경여목적:뇌시유선암상견전이부위지일,유선암뇌전이발생솔재10%～15%,반뇌전이적유선암환자예후교차.본연구목적재우분석4충불동아형유선암뇌전이환자적림상특정급예후인소.방법:회고분석1997년10월지2008년7월중산대학종류방치중심수치적89례뇌전이환자적자료,포괄도관A형30례,도관B형20례,HER-2형16례,삼음형14례,령9례면역조화결과불상.분석4충유선암뇌전이환자초진시적림상병리특정、복발특점、영향복발후환자예후적인소등,병진일보대도관형유선암환자적내분비치료진행연구.결과:전조환자중위년령46세(28～74세),출현뇌전이적시간여초진시적병리분기밀절상관,Ⅰ기환자최장(P<0.001).중위수방시간41.0개월(6.0～141.0개월),전조중위생존시간8.0개월(0～80.0개월),1년생존솔32.0%,5년생존솔4.0%.다인소분석현시,PS평분대우1분、다발전이조、미진행전뇌방료연합화료균시불량예후인소.여도관A형유선암상비,HER-2형화삼음형유선암뇌전이구유발생시간조、일선치료후진전쾌(8.0개월 vs.11.0개월)、총생존기단(25.0개월vs.63.0개월)등특점,도관A형구유진전완만、예후호적경향,타막석분능개선도관A형화도관B형환자적생존(중위생존시간24.0개월vs.7.0개월,P=0.002).결론:유선암뇌전이생존기교단,기중HER-2형화삼음형예후경차.치료이전뇌방료연합화료위주.도관형환자접수타막석분치료유생존획익.
Background and Objective: The brain is one of the most common metastatic sites of breast cancer.Brain metastases develop in10%-15% of patients with breast cancer and are associated with poor prognosis.The purpose of this retrospective study was to analyze the clinical characteristics and survival of patients with brain metastases due to breast cancer of different subtypes and to identify the prognostic factors that affect clinical outcome.Method: A total of 89 patients with breast cancer brain metastases diagnosed between October 1997 and July 2008 at Sun Yat-sen University Cancer Center were included in this study.Among the 89 patients,the number of luminal A,luminal B,human epidermal growth factor receptor2(HER-2),and triple-negative(TN)subtypes were 30,20,16,and 14,respectively; 9 patients had an unknown subtype.The clinical characteristics,pathologic features,and prognostic factors were analyzed both at the initial diagnosis and at the diagnosis of brain metastases.Endocrine therapy for patients with luminal subtypes was further studied.Result: The median age of patients was 46 years(range 28-74 years).The median survival time was8.0 months(range 0-80 months),the 1-year survival rate was 32% and the5-year survival rate was 4%.The time to brain metastasis differed according to clinical stage at initial diagnosis,and the time for patients with the luminal A subtype was the longest(P<0.001).Multivariate analysis demonstrated that performance status score>1,multiple brain metastases and without whole brain radiotherapy(WBRT)in combination with chemotherapy were associated with poor prognosis.Compared with the luminal A subtype,features of the HER-2 and TN subtypes included early metastases,rapid progression after first-line treatment(8.0 months vs.11.0 months),and poor overall survival(25.0 months vs.63.0 months).The luminal A subtype showed a tendency for good prognosis and slow growth.Tamoxifen could improve the survival of luminal A/B subtypes(median survival 24.0 months vs.7.0 months,respectively,P=0.002).Conclusions: The prognosis of brain metastases from breast cancer was poor,especially in patients with HER-2 and TN subtypes.Generally,WBRT in combination with chemotherapy was the standard treatment modality.Patients with the luminal subtypes could benefit from tamoxifen.