CAJ | 학술논문

目的分析乳腺癌脑转移患者的临床病理特点,探讨影响乳腺癌脑转移患者预后的因素.方法回顾性分析2002年6月至2008年6月收治的137例女性乳腺癌脑转移患者的临床病理及随访资料；初诊年龄25 ～ 77岁,平均49.7岁.三阴型乳腺癌(TNBC)35例,激素受体(HR)(-)/人类表皮生长因子受体2 (HER-2)(+)型38例,HR(+)/HER-2(-)型40例,HR(+)/HER-2(+)型24例,分析患者临床特征及其对预后的影响.结果 137例乳腺癌患者发生脑转移后的总体中位生存期是6.5个月,TNBC、HR(-)/HER-2(+)、HR(+)/HER-2(-)、HR(+)/HER-2(+)分别为5.0、5.5、10.0和9.5个月.接受包括全脑放疗在内的综合治疗、仅接受全脑放疗、未接受全脑放疗的患者中位生存期为15.0、9.5、4.0个月.单因素分析显示,分子亚型分类、脑转移灶个数、是否以脑为首发转移部位、是否单纯脑转移以及脑转移后综合治疗状况是影响预后的因素(x2=6.891～ 29.414,P＜0.05).多因素分析证实分子亚型分类(RR=1.234,95％ CI:1.057 ～1.440)、脑转移后综合治疗状况(RR=1.838,95％ CI:1.389～2.431)是影响预后的独立因素(P＜0.05).结论乳腺癌脑转移患者中TNBC预后最差.乳腺癌患者一旦发生脑转移应积极进行包括全脑放疗在内的外科综合治疗.
목적 분석유선암뇌전이환자적림상병리특점,탐토영향유선암뇌전이환자예후적인소.방법 회고성분석2002년6월지2008년6월수치적137례녀성유선암뇌전이환자적림상병리급수방자료；초진년령25 ～ 77세,평균49.7세.삼음형유선암(TNBC)35례,격소수체(HR)(-)/인류표피생장인자수체2 (HER-2)(+)형38례,HR(+)/HER-2(-)형40례,HR(+)/HER-2(+)형24례,분석환자림상특정급기대예후적영향.결과 137례유선암환자발생뇌전이후적총체중위생존기시6.5개월,TNBC、HR(-)/HER-2(+)、HR(+)/HER-2(-)、HR(+)/HER-2(+)분별위5.0、5.5、10.0화9.5개월.접수포괄전뇌방료재내적종합치료、부접수전뇌방료、미접수전뇌방료적환자중위생존기위15.0、9.5、4.0개월.단인소분석현시,분자아형분류、뇌전이조개수、시부이뇌위수발전이부위、시부단순뇌전이이급뇌전이후종합치료상황시영향예후적인소(x2=6.891～ 29.414,P＜0.05).다인소분석증실분자아형분류(RR=1.234,95％ CI:1.057 ～1.440)、뇌전이후종합치료상황(RR=1.838,95％ CI:1.389～2.431)시영향예후적독립인소(P＜0.05).결론 유선암뇌전이환자중TNBC예후최차.유선암환자일단발생뇌전이응적겁진행포괄전뇌방료재내적외과종합치료.
Objective To investigate the clinicopathological characteristics and prognosis in breast cancer with brain metastasis (BCBM).Methods The clinical data of 137 BCBM from June 2002 to June 2008 was reviewed and analyzed.Their molecular subtypes were categorized based on detection of estrogen receptor (ER),progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression.The focal area included 35 cases of triple-negative breast cancer (TNBC),38 cases of HR (ER andPR) (-)/HER-2 (+),40casesofHR (+)/HER-2 (-),24 cases ofHR (+)/HER-2(+).The clinical characteristics and the outcome in patients with influence were analyzed.Results In 137 BCBM,the median overal survival after brain metastasis was 6.5 month.The median survivals of TNBC,HR (-)/HER-2 (+),HR (+)/HER-2 (-) and HR (+)/HER-2 (+) were 5.0,5.5,10.0 and 9.5 months,respectively.The median survivals after brain metastasis of the breast cancer patients who received the combination therapy of whole brain radiation therapy (WBRT) and neurosurgery and/or stereotactic radiosurgery,received WBRT but not combination therapy and didn't receive WBRT were 15.0,9.5 and 4.0 months,respectively.In univariate survival analysis,substyle,number of brain metastasis,brain metastasis as initial recurrence or not,brain-only metastases or not,the combination therapy status after brain metastasis were obviously correlated with the prognosis (x2 =6.891 to 29.414,P ＜ 0.05).Substyle (RR =1.234,95％ CI:1.057 to 1.440) and the combination therapy status after brain metastasis (RR =1.838,95％ CI:1.389 to 2.431) were independent prognostic factor in multivariable analysis (P ＜0.05).Conclusions TNBC confers a high risk of death after brain metastases.Systemic treatment viacombined modalities are helpful for breast cancer patients,even after the detection of brain metastases.