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。

Clinical features and prognosis analysis of patients with breast cancer brain metastases in different subtypes

Objective To investigate the clinical characteristics and prognosis of patients with breast cancer brain metastases （BCBM） in different molecular subtypes. Methods We retrospectively ana- lyzed the clinicopathology features and survival time of 201 breast cancer patients with brain metastases. Pa- tients were divided into 3 subgroups based on hormone receptor（HR） and human epidermal growth factor re- eeptor-2（HER-2） status of the primary cancer. Results Among all 201 cases, 68（33. 8% ） were luminal subtype, 87（43. 3% ） were HER-2 positive subtype and 46（22.9% ） were triple negative breast cancer （TNBC）. The lung, bone, liver and brain were the most common initial distant metastatic sites, with 68 eases（33. 8 % ）, 63 eases（31.3 % ） ,52 cases（25.9% ） and 27 eases（ 13.4 % ）, respectively. The lu- minal type group patients have higher proportion（41.2% ） for bone metastasis; HER-2-positive patients were account for majority of the liver metastasis（ 35.6% ） and the TNBC were more frequently（ 30. 4% ） spread to brain. The median time to brain metastasis（Tl＇BM） was 18. 1 months in luminal cases, 16. 8 months in HER-2-positive cases, and 8.3 months in TNBC, （ P = 0. 005） ; The overall survival time for each group was 95.7 months,72.2 months and 41.6 months respectively（P =0. 002）. The TYBM be- tween HER-2-positive with anti-HER-2 therapy before BM development and HER-2-positive without anti- HER-2 therapy was significantly different （21.9 VS 7. 2 months, P = 0. 002）. Conclusion The lung, bone, liver and brain are the most common distant metastatic sites. Compared with patients of other sub- types, TNBC patients have higher risk of brain metastases and poorer prognosis. TNBC and HER-2-positive without target therapy patients were associated with shorter TTBM. Anti-HER-2 therapy can delay the occur- rence of brain metastases.