不同分子亚型乳腺癌脑转移患者的临床特征和预后
불동분자아형유선암뇌전이환자적림상특정화예후
Breast cancer brain metastases: clinical and prognostic characteristics of different biological subtypes
  • 万方数据
    中华肿瘤杂志 중화종류잡지
    CHINESE JOURNAL OF ONCOLOGY
    2014年 9期 697-701 ,共5页

    张童童%李青%徐兵河%张频%袁芃%马飞%王佳玉%樊英

    장동동%리청%서병하%장빈%원봉%마비%왕가옥%번영

    乳腺肿瘤%肿瘤转移,脑%分子分型%临床特征%预后 乳腺腫瘤%腫瘤轉移,腦%分子分型%臨床特徵%預後
    유선종류%종류전이,뇌%분자분형%림상특정%예후
    Breast neoplasms%Neoplasm metastases,brain%Biological subtype%Clinical characteristics%Prognosis
    目的 分析不同分子亚型乳腺癌脑转移患者的临床特征和预后.方法 回顾性分析2003年1月至2012年12月中国医学科学院肿瘤医院收治的152例乳腺癌脑转移患者的临床资料,根据分子分型分为管腔型(Luminal型)、人表皮生长因子(HER-2)过表达型和三阴性(TNBC)3个分子亚型,分析3个亚型患者初诊时的临床病理特征、复发情况、全身系统治疗情况以及预后.结果 152例患者中,Luminal型60例,HER-2过表达型53例,TNBC型39例.全组患者首次复发或转移后发生脑转移的中位时间为7.3个月,其中Luminal型、HER-2过表达型和TNBC型患者的中位时间分别为11.0、9.6和5.5个月,差异有统计学意义(P＜0.001).首次复发或转移后,HER-2过表达型较TNBC型患者出现脑转移的时间推迟(P=0.001).HER-2过表达型患者中,既往应用曲妥珠单抗可明显推迟患者发生脑转移的时间(分别为17.1和1.7个月,P＜0.001).全组患者的中位总生存时间(OS)为56.5个月,其中Luminal型、HER-2过表达型和TNBC型患者的中位OS分别为70.9、53.9和40.9个月,差异有统计学意义(P =0.013).全组患者脑转移后的中位OS为11.5个月,Luminal型、HER-2过表达型和TNBC型患者的中位OS分别为11.2、12.7和11.6个月,差异无统计学意义(P =0.879).与继发脑转移者(8.0个月)比较,首发脑转移患者的中位OS明显延长(14.8个月,P=0.001).脑转移后,单独应用全身化疗、全身化疗联合靶向治疗以及未行全身治疗患者的中位OS分别为13.6、19.0和6.5个月,差异有统计学意义(P =0.043).多因素分析显示,KPS评分、首发脑转移、脑转移后全身系统治疗均可影响患者脑转移后的生存.结论 乳腺癌脑转移患者的预后与分子分型有关,与Luminal型比较,HER-2过表达型和TNBC型患者易于早期出现脑转移.既往应用曲妥珠单抗可推迟HER-2过表达型患者发生脑转移的时间,全身系统治疗可改善脑转移患者的预后.
    목적 분석불동분자아형유선암뇌전이환자적림상특정화예후.방법 회고성분석2003년1월지2012년12월중국의학과학원종류의원수치적152례유선암뇌전이환자적림상자료,근거분자분형분위관강형(Luminal형)、인표피생장인자(HER-2)과표체형화삼음성(TNBC)3개분자아형,분석3개아형환자초진시적림상병리특정、복발정황、전신계통치료정황이급예후.결과 152례환자중,Luminal형60례,HER-2과표체형53례,TNBC형39례.전조환자수차복발혹전이후발생뇌전이적중위시간위7.3개월,기중Luminal형、HER-2과표체형화TNBC형환자적중위시간분별위11.0、9.6화5.5개월,차이유통계학의의(P＜0.001).수차복발혹전이후,HER-2과표체형교TNBC형환자출현뇌전이적시간추지(P=0.001).HER-2과표체형환자중,기왕응용곡타주단항가명현추지환자발생뇌전이적시간(분별위17.1화1.7개월,P＜0.001).전조환자적중위총생존시간(OS)위56.5개월,기중Luminal형、HER-2과표체형화TNBC형환자적중위OS분별위70.9、53.9화40.9개월,차이유통계학의의(P =0.013).전조환자뇌전이후적중위OS위11.5개월,Luminal형、HER-2과표체형화TNBC형환자적중위OS분별위11.2、12.7화11.6개월,차이무통계학의의(P =0.879).여계발뇌전이자(8.0개월)비교,수발뇌전이환자적중위OS명현연장(14.8개월,P=0.001).뇌전이후,단독응용전신화료、전신화료연합파향치료이급미행전신치료환자적중위OS분별위13.6、19.0화6.5개월,차이유통계학의의(P =0.043).다인소분석현시,KPS평분、수발뇌전이、뇌전이후전신계통치료균가영향환자뇌전이후적생존.결론 유선암뇌전이환자적예후여분자분형유관,여Luminal형비교,HER-2과표체형화TNBC형환자역우조기출현뇌전이.기왕응용곡타주단항가추지HER-2과표체형환자발생뇌전이적시간,전신계통치료가개선뇌전이환자적예후.
    Objective To analyze the clinical characteristics and survival depending on biological subtypes in breast cancer patients with brain metastases (BM).Methods A retrospective analysis was performed on 152 breast cancer patients with BM admitted to the Cancer Institute & Hospital,Chinese Academy of Medical Sciences from January 2003 to December 2012.Depending on the biological characteristics,these patients were divided into three subtypes:Luminal,human epidermal growth factor receptor 2 (HER-2)-overexpressing,and triple-negative subtypes.The clinicopathological characteristics,recurrence status,and prognostic factors were analyzed at the initial diagnosis.The systemic therapy after BM was further studied.Results Among the 152 patients,the number of Luminal,HER-2-overexpressing,and triple-negative breast cancer (TNBC) subtypes were 60,53,and 39 cases,respectively.The median time from first recurrence to BM of all patients was 7.3 months,the median time of Luminal,HER-2-overexpressing,and TNBC subtypes was 11.0 months,9.6 months,and 5.5 months,respectively (P ＜ 0.001).Compared with the TNBC subtype,BM occurred later in the HER-2-overexpressing subtype (P ＜ 0.001).In the HER-2-overexpressing subtype,trastuzumab could delay the occurrence of BM in advanced breast cancer patients (17.1 vs.1.7 months,P ＜ 0.001,95％ CI 5.21-13.98).The median time of overall survival (OS) in the whole group was 56.5 months (7.5-240.2 months,95％ CI 52.6-60.4).The median survival time of Luminal,HER-2-overexpressing and TNBC subtypes was 70.9 months,53.9 months,and 40.9 months,respectively (P =0.013).The median survival time of after BM was 11.5 months in the whole group,and the median survival time of Luminal,HER-2-overexpressing and TNBC subtypes was 11.2months,12.7 months,and 11.6 months,respectively,with a difference of no statistical significance.Compared with non-BM as the first site,the patients with BM as the first site had a longer survival (14.8months vs.8.0 months,P =0.001).Systemic therapy could prolong the survival after BM.The median survival of chemotherapy,chemotherapy in combination with trastuzumab,and without systemic therapy was 13.6 months,19.0 months,and 6.5 months,respectively (P=0.043).Conclusions The survival after BM is influenced by biological subtypes.Compared with the Luminal subtype,brain meatastases occurr earlier in HER-2-overexpressing and TNBC subtypes.Trastuzumab can delay the occurrence of BM from advanced breast cancer,and systemic therapy can improve the survival of patients after brain metastasis.
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