乳腺癌脑转移68例临床特点及预后因素分析

[目的]分析乳腺癌脑转移患者的临床特点,探讨影响乳腺癌脑转移患者预后的因素。[方法]收集68例乳腺癌脑转移患者临床资料,采用单因素和多因素生存分析影响乳腺癌脑转移患者预后因素。[结果]乳腺癌脑转移患者多为未绝经、浸润性导管癌,首发症状多为颅内高压症状,多为多发颅内转移,多合并颅外转移。乳腺癌脑转移患者中位生存期8.82个月,1、2、3年生存率分别为39%、8%、8%。单因素分析显示KPS评分、合并肝转移、全身化疗、脑部放疗显著性影响乳腺癌脑转移患者的生存期;Cox多因素分析显示脑部放疗、KPS评分是影响乳腺癌脑转移生存的独立预后因素。[结论]脑部放疗、KPS评分是影响乳腺癌脑转移患者生存的独立预后因素。乳腺癌脑转移后的全身化疗价值需进一步探讨。     

脑转移癌放射治疗疗效及预后因素分析

目的:通过对69例脑转移癌放射治疗的疗效及预后因素分析,了解影响患者预后的因素,以便改进治疗方法.方法:71例接受了放射治疗的脑转移癌患者,可评估病例69例,采用全脑放疗或联合局部缩野放射治疗,根据性别、年龄、KPS评分、原发灶状态、转移灶的数目、RPA分级、放疗剂量以及是否转移等进行统计分析,对不同生存情况进行比较.结果:全组中位生存时间7.1个月.放疗总剂量＞30 Gy组中位生存期(8.2个月)明显高于放疗总剂量≤30 Gy组(2.3个月),χ2=4.403,P=0.036.与预后相关的因素有KPS评分、RPA分级、原发灶状态以及是否转移等.患者预后与性别、年龄和转移灶的数目未见明显相关.结论:全脑放疗联合局部缩野放射治疗可有效缓解脑转移癌患者症状,并延长生存期和提高生活质量.     

乳腺癌脑转移放疗的临床疗效和预后分析

目的 观察乳腺癌脑转移的放疗效果,探讨预后相关因素。方法 对接受全脑放疗的56例乳腺癌脑转移病例进行回顾性分析,所有患者均接受全颅放疗,放疗剂量为30 Gy/10Fx。采用Kaplan-Meier法计算总生存和中位生存时间,利用COX比例风险回归模型进行多因素分析患者预后的独立危险因素。结果 确诊乳腺癌脑转移平均年龄为57.9岁(32～82岁),平均随访时间为28.4个月(95%CI:11.6,49.2)。乳腺癌脑转移放疗患者中位生存时间为12.1个月(95%CI:8.7,15.5),1、2年生存率分别为52.6%、26.1%。单因素分析显示：有统计学意义的因素包括GPA评分、无颅外转移、脑转移时KPS评分、是否幕下转移、Her-2表达状态、分子分型、是否肺转移、脑转移放疗后化疗。多因素分析显示：脑转移时KPS(P=0.027)、GPA评分(P=0.036)、分子分型(P=0.042)、无颅外转移(P=0.028)、无肺转移(P=0.002)、脑转移放疗后接受化疗(P=0.034)是乳腺癌脑转移放疗患者预后的独立预后因素。结论 分子分型可作为乳腺癌脑转移的预后指标。脑转移放疗后化疗、无...     

首发中枢神经系统转移的乳腺癌患者临床特点分析

目的 探讨首发中枢神经系统转移的乳腺癌患者的临床特点及预后影响因素.方法 回顾性分析51例以中枢神经系统转移为首发转移的乳腺癌患者的临床病理资料及生存情况及影响预后的因素.结果 全组51例患者,转移后中位生存时间6个月,1年、2年、3年总生存率分别为21.57％(11/51)、2.00％ (8/40)、0(32/32).整组初始治疗的有效率为49.01％(25/51).单因素分析显示临床分期(x2=6.586,P=0.045)、HER2过表达型(x2 =4.018,P=0.042)、三阴型(x2 =8.426,P=0.004)是转移的相关危险因素,多因素分析显示免疫组化三阴性是独立危险因素(x2=6.964,P=0.008).治疗方式(x2=8.407,P=0.019)、首次治疗后疗效(x2=8.324,P=0.010)是影响预后的危险因素.结论 分期晚、三阴性乳腺癌患者应重视中枢神经系统的转移,而且先放疗获益较大.     

46例首诊伴远处转移鼻咽癌的预后分析

目的 回顾性分析初诊时即伴有远处转移的鼻咽癌患者的治疗结果 并探讨其预后.方法 3年余共收治46例初诊伴有远处转移的鼻咽癌患者,其中43例为单器官转移,3例为多器官转移.肝转移19例,骨转移11例,肺转移7例,腋窝淋巴结和纵隔淋巴结各6例,脑转移1例.所有患者均接受了鼻咽部及颈部40～85 Gy放疗.41例接受了1～5周期PF方案化疗,23例接受了远处转移灶姑息性放疗.结果 随访率为100%.1、2、3、5年生存率分别为66%、47%、30%、19%,中位生存时间为20个月.转移灶是否放疗及KPS评分是影响生存的预后因素.转移灶放疗与末放疗的中位生存时间分别为39个月和13个月(X2=8.63,P=0.012),KPS评分≥80和<80的中位生存时间分别为26个月和12个月(X2=3.95,P=0.035).结论 首诊远处转移的鼻咽癌患者得到积极治疗后仍有长期生存可能,KPS评分高者预后好,在全身化疗、原发灶放疗及支持治疗的同时转移病灶局部治疗可能延长生存时间.     

HER2表达强度对三阴性乳腺癌无病生存率的影响

目的：研究免疫组化中表皮生长因子受体2（HER2）表达强度与三阴性乳腺癌（TNBC）无病生存率（DFS）的关系。方法回顾性分析经病理证实的103例TNBC患者的临床病理特征,以及HER2表达强度（阴性、+、2+但HER2基因无扩增）与TNBC治疗后DFS的关系。结果103例TNBC患者的年龄为23～79岁,中位年龄52岁;随访时间60～141个月,中位随访时间90个月,无失访病例;随访期间34例（33.0%）患者出现复发转移。单因素分析显示,HER2表达强度（P=0.012）、肿块大小（P=0.037）、病理组织学分级（P=0.005）、淋巴结转移数目（P﹤0.001）与患者的DFS有关。Cox多因素分析表明,HER2表达强度（P=0.001）、病理组织学分级（P=0.001）、淋巴结转移数目（P﹤0.001）是影响TNBC患者DFS的独立危险因素。结论 HER2表达强度、病理组织学分级、淋巴结转移数目是影响TNBC患者生存独立预后因素。HER2强度越强、病理组织学分级越高、淋巴结转移数目越多,患者DFS越低。     

89例乳腺癌脑转移患者的预后生存分析

目的探讨乳腺癌脑转移患者预后生存的影响因素。方法回顾分析1999年1月至2009年12月中国医学科学院肿瘤医院收治的89例乳腺癌脑转移患者的临床资料,其中HER-2阳性患者24例,HER-2阴性患者65例,分析ER、PR、TNM分期、淋巴结转移状态、Karnofsky评分、病情进展、脑转移情况、治疗措施等因素对乳腺癌脑转移生存期的影响。结果全组患者平均年龄49.0岁(23~74岁),确诊脑转移后中位生存期8.6个月(0.2~61.5个月)。单因素分析显示,乳腺癌脑转移患者HER-2表达阳性者与阴性者1年生存率分别为12.5%和46.2%(P=0.003),中位生存期分别为6.3个月和10.9个月(P=0.003);Karnofsky评分≥60分患者和<60分患者比较,1年生存率分别为43.5%和15.0%(P=0.017),中位生存期分别为10.1个月和5.3个月(P=0.019);非综合治疗组与综合治疗组1年生存率分别为21.6%和48.1%(P=0.014),中位生存期分别为6.0和13.6个月(P=0.006);内分泌治疗组与未采用内分泌治疗组1年生存率分别为66.7%和32.5%(P=0.027),中位生存期分别为29.3个月和8.5个月(P=0.003)。Cox多因素分析提示,HER-2表达状态、Karnofsky评分及是否综合治疗影响患者生存及预后。结论 HER-2表达状态、Karnofsky评分及脑转移后是否综合治疗是影响乳腺癌脑转移生存预后的因素,综合治疗有助于改善预后,延长生存。     

不同亚型乳腺癌脑转移患者的临床特征和生存分析

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(P0.001)。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。     

乳腺癌脑转移67例临床分析

背景与目的:随着乳腺癌全身治疗疗效的提高和患者生存期的延长,乳腺癌脑转移在临床上越来越常见。本研究通过分析乳腺癌脑转移的临床特点,探讨其治疗方式及预后因素。方法:67例患者出现脑转移距离确诊乳腺癌的时间为0～15年,中位时间为2.5年。治疗方式为手术加放疗3例,单纯放疗30例,单纯化疗3例,放疗加化疗26例,未治疗5例。采用SPSS10.0统计软件进行生存分析,采用Kaplan-Meier分析和log-rank检验进行生存预后分析。结果:乳腺癌脑转移最常见的症状是头痛,脑实质为最常受累部位。全组患者中位生存期为4年,出现脑转移后的中位生存时间为11个月。月经状况、脑转移数目、合并全身转移情况及治疗方式对患者的生存时间均无明显影响。结论:乳腺癌脑转移预后差,目前治疗仍以全脑放疗为主,化疗的作用还需进一步研究。     

非小细胞肺癌脑转移瘤不同治疗方法的疗效评价以及预后分析

目的:评价非小细胞肺癌脑转移瘤患者接受不同治疗方法的疗效和生存预后因素.方法:分析2009年8月-2012年2月我科收治的71例肺癌脑转移患者的临床特点,用SPSS16.0软件进行统计学分析,Kaplan-Meier法和Log rank法分析比较生存期,Cox模型进行多因素回归分析,非参数检验根据Mann-Whitney U方法比较脑局部控制率.结果:单因素分析结果提示脑部放疗方式、原发灶治疗方式、T分期、KPS评分、颅外转移数目对患者生存期有影响(P＜0.05).Cox模型多因素分析显示脑转移瘤不同治疗方案为独立预后因素(P =0.0001).71例病例中20例(28.2％)给予单纯脑部放疗,13例(18.3％)给予单纯全身化疗,16例(22.5％)进行脑部放疗+全身化疗联合治疗,22例(31.O％)仅给予最佳支持治疗.放化疗联合治疗在脑部局部控制率(62.5％)均优于单纯全身化疗(15.4％)以及单纯全脑放疗(35.0％,P =0.0002),且在中位生存期(37.1个月)明显优于单纯全身化疗(8.7个月)以及单纯全脑放疗(18.8个月,P=0.0003).结论:脑转移瘤不同治疗方案是影响预后的独立因素,在患者身体条件允许情况下,全脑放疗联合多学科综合治疗为最佳治疗模式.     

Clinical Characteristics and Survival Analysis of Breast Cancer Molecular Subtypes with Hepatic Metastases

Background: The liver is one of the most common metastatic sites of breast cancer, hepatic metastasesdeveloping in 6%-25% of patients with breast cancer and being associated with a poor prognosis. The aim ofthis study was to analyze the survival and clinical characteristics of patients with hepatic metastases from breastcancer of different molecular subtypes and to investigate the prognostic and predictive factors that effect clinicaloutcome. Methods: We retrospectively studied the charts of 104 patients with breast cancer hepatic metastasesdiagnosed at Sun Yat-sen University Cancer Center from December 1990 to June 2009. Subtypes were definedas luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) enriched, triple-negative (TN).Prognostic factor correlations with clinical features and treatment approaches were assessed at the diagnosis ofhepatic metastases. Results: The median survival time was 16.0 months, and the one-, two- three-, four-, fiveyearsurvival rates were 63.5%, 31.7%, 15.6%, 10.8%, and 5.4%, respectively. Median survival periods afterhepatic metastases were 19.3 months (luminal A), 13.3 months (luminal B), 18.9 months (HER2-enriched), and16.1 months (TN, P=0.11). In multivariate analysis, a 2 year-interval from initial diagnosis to hepatic metastasis,treatment with endocrine therapy, and surgery were independent prognostic factors. Endocrine therapy couldimprove the survival of luminal subtypes (P=0.004) and was a favorable prognostic factor (median survival 23.4months vs. 13.8 months, respectively, P=0.011). Luminal A group of patients treated with endocrine therapy didsignificantly better than the Luminal A group of patients treated without endocrine therapy (median survivalof 48.9 vs. 13.8 months, P=0.003). Conclusions: Breast cancer subtypes were not associated with survival afterhepatic metastases. Endocrine therapy was a significantly favorable treatment for patients with luminal subtype.     

不同分子亚型乳腺癌脑转移患者的临床特征和预后分析

目的探讨不同分子亚型乳腺癌脑转移(BCBM)患者的临床特点和预后。方法收集201例BCBM患者的临床资料,根据原发肿瘤激素受体及表皮生长因子受体2(HER-2)表达状态,将患者分为3个不同分子亚型,并分析不同亚型BCBM患者的临床特征及生存情况。结果 201例患者中,Luminal型68例(33.8%),HER-2型87例(43.3%),三阴型46例(22.9%)。全组患者初始转移部位依次为肺68例(33.8%)、骨63例(31.3%)、肝52例(25.9%)和脑27例(13.4%)。不同亚型患者初始转移部位不同(P<0.05),Luminal型患者骨转移的发生率最高(41.2%),HER-2型肝转移的发生率为35.6%,三阴型患者脑转移的发生率为30.4%。不同亚型患者首次复发至出现脑转移时间(TTBM)不同Luminal型为18.1个月,HER-2型为16.8个月,三阴型患者为8.3个月,差异有统计学意义(P=0.005);Luminal型患者总生存时间为95.7个月,HER-2型总生存时间为72.2个月,三阴型患者总生存时间为41.6个月,差异有统计学意义(P=0.002)。HER-2型患者脑转移前采用抗HER-2治疗的TTBM为21.9个月,较未行抗HER-2治疗的TTBM(7.2个月)明显延长(P=0.002)。结论肺、骨、肝和脑是乳腺癌最常见的远处转移部位。三阴型乳腺癌患者容易发生脑转移且预后最差,三阴型和HER-2型未行抗HER-2治疗患者容易早期出现脑转移,抗HER-2治疗可以延缓脑转移的发生。     

不同病理亚型乳腺癌脑转移患者预后分析

目的:了解不同病理亚型乳腺癌脑转移患者的预后特点。方法:根据肿瘤组织免疫组化ER、PR、HER-2 的表达情况将89例患者分为4 组:Luminal A型（ER+ 和/或PR+ ,HER-2-）17例、Luminal B型（ER+ 和/或PR+ ,HER-2 +）15例、HER-2 + 型（ER- ,PR- ,HER-2 +）24例和Basal-like型（ER- ,PR- ,HER-2-）33例。主要观察4 组患者分布比例、发病年龄、月经状态、病理类型、病理分级、肿瘤大小、淋巴结状态及脑转移发生距手术时间及部位等。使用SPSS15.0 统计软件进行数据分析,定量资料采用t检验,计数资料比较采用卡方检验,生存率计算采用Kaplan-Meier 法并用Log-rank 检验,P<0.05为差异有统计学意义。结果:所有患者当中Basal-like型所占比例最高（37.1%）,其次为HER-2 +（27%）,Luminal A型（19.1%）,Luminal B型最少（16.9%）。 Basal-like 型患者预后最差,其病理分级Ⅲ级的患者比例达到了73% 。在其他部位出现转移情况上,Luminal型患者表现出较高的骨转移倾向。全组患者的中位生存期为47个月,无病生存期为20个月,确诊脑转移后的生存期为9 个月。ER（-）且PR（-）较ER/PR（+）（45个月vs.52个月,P=0.006）、HER-2（+）较HER-2（-）（45个月vs.51.5 个月,P=0.04）、Basal-like亚型的患者预后较其他亚型差（33个月vs.52个月,P=0.000）。 结论:病理亚型是判断乳腺癌脑转移患者预后不同的良好指标,ER（-）且PR（-）、HER-2（+）、Basal-like亚型患者容易出现脑转移且预后较差。      

Patterns of care and outcomes of multi-agent versus single-agent chemotherapy as part of multimodal management of low grade glioma

Brain metastases are a serious relatively common complication of breast cancer. We evaluated prognostic factors for survival after diagnosis of brain metastases from breast cancer in a contemporary cohort of patients. Patients diagnosed with breast cancer brain metastases at our institution between 1999 and March 2016 were evaluated. Overall survival was defined as time from brain metastasis diagnosis to death or last follow-up. Patients were classified according to the Breast cancer-specific Graded Prognostic Assessment (BS-GPA), based on age, Karnofsky performance score and breast cancer phenotype. 181 patients were identified. Tumor phenotype distribution was as follows: triple negative (TN, 18.8%), hormone receptor (HR)?HER2+ (16.6%), HR+HER2+ (23.2%) and HR+HER2? (30.9%), not available (10.5%). Median overall survival from brain metastasis diagnosis was 7.7 mos (95% CI 5.4–10.0 mos). Although TN patients experienced the worse outcome, no significant difference was observed across tumor phenotypes (median 5.1, 7.7, 11.0 and 8.6 months in TN, HR?HER2+, HR+HER2+, HR+HER2?, p?=?0.081). The BS-GPA index was significantly associated with overall survival (median 18.8, 8.8, 6.2 and 3.6 months, respectively, for BS-GPA categories 3.5–4, 2.5–3, 1.5–2 and 0–1, p?=?0.014). Increased number of local treatments for brain metastasis (radiotherapy or neurosurgery) or the administration of systemic therapy after brain metastasis diagnosis were also significant predictors of better overall survival (p?<?0.001) and, when evaluated in multivariate analysis with BS-GPA, both added independent prognostication beyond BS-GPA. Patient-related features, tumor phenotype and multimodal treatments all independently contribute to modulate prognosis of patients diagnosed with breast cancer brain metastases.     

363例Luminal型乳腺癌的临床病理特点及预后分析

目的:探讨Luminal型不同分子亚型乳腺癌患者临床病理特点以及预后影响因素。方法:收集2006年1月至2013年2月诊治的363例Luminal型乳腺癌患者的临床和随访资料,分为Luminal A、Luminal B以及Luminal-HER2三组并分析临床病理参数与预后相关的因素。结果:363例Luminal型乳腺癌三种分子分型所占比例为51.5%、38.8%、9.7%,三组的发病年龄、肿瘤大小、组织学分级、淋巴结转移差异具有统计学意义（P<0.05）。局部复发率分别为2.7%、7.1%、20.0%;远处转移率为6.4%、12.1%、20.0%,Luminal-HER2型乳腺癌显著高于其余两组,且5年的无病生存以及总生存率明显低于其余两组,差异有统计学意义（P<0.05）。单因素分析和Cox多因素分析结果发现肿瘤大小、淋巴结转移、PR、HER2及内分泌治疗是Luminal型乳腺癌预后的独立影响因素(P<0.05)。结论:Luminal型乳腺癌中HER2过表达亚型患者侵袭性更强,预后更差。肿瘤较大、淋巴结转移、PR阴性、HER2过表达及未进行内分泌治疗是影响Luminal型乳腺癌预后的独立危险因素。     

Breast cancer brain metastases: differences in survival depending on biological subtype,RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT)

Background: Patients with breast cancer brain metastasis are a heterogeneous group in relation to tumor biology and outcome.Materials and methods: The group of 222 breast cancer patients with brain metastasis was divided into three biological subgroups. The propensity of biological subtypes for metastases to the brain and survivals depending on biological subtype, recursive partitioning analysis of Radiation Therapy Oncology Group (RPA RTOG) prognostic class and the use of systemic treatment after whole-brain radiotherapy were assessed.Results: The rate of patients with triple-negative, human epidermal growth factor receptor 2 (HER2)-positive and luminal breast cancer with brain metastases was 28%, 53% and 19%, respectively. Median survival from brain metastases in triple-negative, HER2-positive and luminal subtype was 3.7, 9 and 15 months, respectively. Median survival from brain metastases in RPA RTOG prognostic class I, II and III was 15, 11 and 3 months, respectively. In the luminal and in the triple-negative subtype, systemic therapy prolonged survival from 3 to 14 months and from 3 to 4 months, respectively. In HER2-positive subtype, median survival without further treatment, after chemotherapy and after chemotherapy with targeted therapy were 3, 8 and 11 months, respectively.Conclusions: HER2-positive and triple-negative breast cancers have special predilection for metastases to the brain. Survival from brain metastases depended on performance status and the use of systemic treatment.     

76例乳腺癌脑转移患者临床特征及预后因素分析

目的 分析乳腺癌脑转移患者临床病理特征,探讨影响乳腺癌脑转移患者的预后因素.方法 收集76例乳腺癌脑转移患者的临床病理资料,采用单因素和多因素分析影响乳腺癌脑转移患者的预后因素.结果 乳腺癌患者确诊脑转移后中位生存期为8.4个月,1年生存率为31.6%,2年生存率为7.9%,3年生存率为3.9%.多因素分析提示未放疗、PS评分≥2分、多发颅内转移灶、分子分型为Her-2型及三阴型均是乳腺癌脑转移患者的不良预后因素.Lumin-al A、Luminal B、Her-2型及三阴型乳腺癌患者中位无脑转移生存期(46.8个月、34个月、26.8个月和17.6个月,P=0.005)、确诊脑转移后生存期(16.9个月、9.5个月、7.6个月和5.5个月,P=0.001)和总生存期(64.3个月、40.9个月、31.7个月和24.1个月,P=0.001)差异均有统计学意义.结论 放疗、PS评分、脑转移灶数目及分子分型是影响乳腺癌脑转移患者的独立预后因素;与Luminal型乳腺癌相比,Her-2型及三阴型乳腺癌更易早期发生脑转移,且生存期更短.     

Leptomeningeal metastases from breast cancer: intrinsic subtypes may affect unique clinical manifestations

Leptomeningeal metastasis (LM) usually occurs late during the course of breast cancer. The aim of this study was to characterize the clinical features and outcomes of LM based on breast cancer subtypes in conjunction with brain parenchymal metastases. A retrospective study was performed of breast cancer patients with LM, who received palliative management at Samsung Medical Center between 1995 and 2008. Among the 272 metastatic breast cancer patients with central nervous system (CNS) involvement, 68 patients with LM were identified. The median age was 46 years (range, 24-72 years). The median survival duration from LM to death (LM-OS) was 4.5 months (range, 0.2-26.4 months). Patients surviving for 12 or more months were rarer among triple negative (TN) patients compared to other subtypes (21.7% for HR + ve vs. 27.8% for HER2 + ve vs. 72.7% for TN, P = 0.217). Death caused by CNS involvement appeared to be much more common in TN than in other subtypes (0% for HR + ve vs. 36% for HER2 + ve vs. 64% for TN, P = 0.060). Median survival time from distant metastasis was significantly different among the three groups (28.3 vs. 29.1 vs. 11.8 months, P < 0.0001). However, median survival time from LM did not differ (4.1 vs. 5.9 vs. 3.8 months, P = 0.226). Characteristic manifestations and treatment outcomes of LM may be affected by the unique biology of breast cancer intrinsic subtypes. The different roles of active combined treatment modalities including both systemic chemotherapy and local treatment modalities should be considered to improve outcomes.     

Triple-negative breast cancer with brain metastases: a comparison between basal-like and non-basal-like biological subtypes

The aim of this study was to divide the group of triple-negative breast cancer patients with brain metastases into basal-like and non-basal-like biological subtypes in order to compare clinical features and survival rates in those two groups. A comprehensive analysis of 111 consecutive triple-negative breast cancer patients with brain metastases treated in the years 2003–2009 was performed. In 75 patients, immunohistochemistry was used as a surrogate of microarray in order to evaluate the expression of three basal markers: cytokeratin 5/6 (CK 5/6), EGFR/HER1 and c-KIT. The basal-like (ER/PgR/HER2-negative, CK5/6positive and/or HER1-positive) and non-basal-like (ER/PgR/HER2-negative, CK5/6-negative, HER1-negative) subsets were selected. Clinical features and survivals were compared in both groups. In the group of 111 triple-negative breast cancer patients, median DFS, OS and survival from brain metastases were 20, 29 and 4 months, respectively. In 75 patients who were evaluable for basal markers, median DFS, OS and survival from brain metastases were 18, 26 and 3.2 months, respectively. In the basal-like subtype, the survival rates were 15, 26 and 3 months, respectively, and in the non-basal-like subtypes, they were 20, 30 and 2.8 months, respectively. No statistically significant differences in survivals were detected between the basal-like and non-basal-like biological subtypes. Factors influencing survival from brain metastases were: Karnofsky performance status (KPS), the status of extracranial disease and age. Biological markers differentiating triple-negative group into basal-like and non-basal-like subtype (CK 5/6, HER1, c-KIT) had no influence on survival. In patients with triple-negative breast cancer and brain metastases, well-known clinical, but not molecular, features correlated with survival.     

不同激素状态的HER2阳性晚期乳腺癌复发转移特征及生存分析

 目的 探讨不同HR状态的HER2阳性晚期乳腺癌患者的复发转移特征、预后及解救曲妥珠单抗治疗疗效的差异。方法 回顾性分析237名HER2阳性晚期乳腺癌患者的临床病理学资料，根据HR状态分为HR+/HER2+组和HR-/HER2+组，对两组间临床病理学特征、复发转移特点、预后及解救曲妥珠单抗治疗疗效进行分析比较。结果 与HR-/HER2+相比，HR+/HER2+多为绝经前患者，临床分期以Ⅰ~Ⅱ期为主，T分期更早，较少发生腋窝淋巴结转移。在总体复发转移部位上HR+/HER2+者更易发生骨转移，较少发生肺转移。HR+/HER2+组中位总生存时间34（5~102）月，HR-/HER2+组为29（3~70）月，两组间差异有统计学意义。接受解救曲妥珠单抗联合化疗的患者，ER<50%者达PR者占68.6%，ER≥50%者占46.2%，差异有统计学意义（P=0.037）。多因素分析结果显示ER状态是HR+/HER2+晚期乳腺癌的独立预后因素；肝转移、解救抗HER2靶向治疗是HR-/HER2+晚期乳腺癌的独立预后因素。结论 与HR-/HER2+患者相比，HR+/HER2+患者多发生骨转移，较少发生肺转移；预后较好；ER阳性细胞数所占比例较高的患者解救曲妥珠单抗治疗疗效较差。