The shifting landscape of metastatic breast cancer to the CNS
The shifting landscape of metastatic breast cancer to the CNS
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DOI：
10.1007/s10143-012-0446-6
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发表时间：
2013-07-01
影响因子：
2.8
通讯作者：
Karlovits, Steven
中科院分区：
文献类型：
--
作者：
Quigley, Matthew R.;Fukui, Olivia;Karlovits, Steven
乳腺癌诊断后生存率的提高可能会改变CNS受累患者的特征和病程。因此，我们试图从现代生物标志物和临床结局方面来定义我们目前的CNS转移性乳腺癌患者队列。审查因新诊断为乳腺癌CNS转移性疾病而到三级医疗中心就诊的女性的临床和影像学记录。这是一项回顾性综述，患者身份来自两个前瞻性数据库。有88名妇女在2003年1月至2010年2月期间接受了治疗，平均年龄为56.9岁。在最初出现CNS疾病时，68%的患者有多发性脑转移，17%有孤立性转移，15%只有软脑膜疾病（LMD）。所有患者从诊断乳腺疾病开始的中位生存期为50.0个月，从诊断CNS受累开始的中位生存期为9.7个月。与总生存率相关的唯一因素是雌激素受体阳性病理学（57.6 v. 38.2个月，p = 0.02对数秩）;与CNS诊断后生存率相关的因素是LMD（p = 0.004，HR = 3.1，考克斯回归）和三阴性激素/HER 2状态（p = 0.02，HR = 2.3，考克斯回归）。患者的中位生存期为3.1个月（没有共同的患者）。在最初表现为转移性脑病变的75例患者中，20例（26%）随后在其疾病过程中发展为LMD（中位数10.4个月），此后生存率很低（中位数1.8个月）。LMD最常见的症状是下肢无力（14/33），其次是颅神经缺损（11/33）。最近描述的分级预后评估（GPA）肿瘤指数将中位生存期分别分层为2.5、5.9、13.1和21.7个月，指数为1-4（p = 0.004，对数秩），这与放射治疗肿瘤组递归分割分析分类1和2之间的无显著生存差异形成对比。(13.1 v. 13.2，p = .8，对数秩）。乳腺癌脑转移患者的治疗应根据患者的激素状态和GPA指数进行调整。从业者必须警惕LMD的发展，特别是因为它经常出现难以描述的投诉，如背痛。
The improved survival following the diagnosis of breast cancer has potentially altered the characteristics and course of patients presenting with CNS involvement. We therefore sought to define our current cohort of breast cancer patients with metastatic disease to the CNS in regard to modern biomarkers and clinical outcome. Review of clinical and radiographic records of women presenting to a tertiary medical center with the new diagnosis of CNS metastatic disease from breast cancer. This was a retrospective review from patients identities obtained from two prospective databases. There were 88 women analyzed who were treated over the period of January 2003 to February 2010, average age 56.9 years. At the time of initial presentation of CNS disease, 68 % of patients had multiple brain metastases, 17 % had a solitary metastasis, and 15 % had only leptomeningeal disease (LMD). The median survival for all patients from the time of diagnosis of breast disease was 50.0 months, and 9.7 months from diagnosis of CNS involvement. The only factor related to overall survival was estrogen receptor-positive pathology (57.6 v. 38.2 months, p = .02 log-rank); those related to survival post CNS diagnosis were presentation with LMD (p = .004, HR = 3.1, Cox regression) and triple-negative hormonal/HER2 status (p = .02, HR = 2.3, Cox regression). Patients with either had a median survival of 3.1 months (no patients in common). Of the 75 patients who initially presented with metastatic brain lesions, 20 (26 %) subsequently developed LMD in the course of their disease (median 10.4 months), following which survival was grim (1.8 months median). Symptoms of LMD were most commonly lower extremity weakness (14/33), followed by cranial nerve deficits (11/33). The recently described Graded Prognostic Assessment (GPA) tumor index stratified median survival at 2.5, 5.9, 13.1, and 21.7 months, respectively, for indices of 1-4 (p = .004, log-rank), which contrasted with the nonsignificant survival difference between Radiation Therapy Oncology Group Recursive Partitioning Analysis classes one and two. (13.1 v. 13.2, p = .8, log-rank). Treatment of patients with metastatic brain disease from breast cancer should be tailored to the patient's hormonal status and GPA index. Practitioners must be vigilant for the development of LMD, especially as it often presents with nondescript complaints such as back pain.