乳腺癌亚型与初诊时脑转移乳腺癌患者的死亡率：一项基于人群的研究。
Breast Cancer Subtypes and Mortality of Breast Cancer Patients With Brain Metastasis at Diagnosis: A Population-Based Study.
机构信息
Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China.
出版信息
Inquiry. 2021 Jan-Dec;58:469580211055636. doi: 10.1177/00469580211055636.
BACKGROUND
Brain metastasis is an important cause of breast cancer-related death.
AIM
We evaluated the relationships between breast cancer subtype and prognosis among patients with brain metastasis at the initial diagnosis.
METHODS
The Surveillance, Epidemiology, and End Results database was searched to identify patients with brain metastasis from breast cancer between 2010 and 2015. Multivariable Cox proportional hazard models were used to identify factors that were associated with survival among patients with initial brain metastases. The Kaplan-Meier method was used to compare survival outcomes according to breast cancer subtype.
RESULTS
Among 752 breast cancer patients with brain metastasis at diagnosis, 140 patients (18.6%) underwent primary surgery and 612 patients (81.4%) did not undergo surgery, while 460 patients (61.2%) received chemotherapy and 292 patients (38.8%) did not receive chemotherapy. Multivariable analysis revealed that, relative to HR+/HER2- breast cancer, HR-/HER2- breast cancer was associated with significantly poorer overall survival (hazard ratio: 2.52, 95% confidence interval: 1.99-3.21), independent of age, sex, race, marital status, insurance status, grade, liver involvement, lung involvement, primary surgery, radiotherapy, and chemotherapy. The median overall survival intervals were 12 months for HR+/HER2-, 19 months for HR+/HER2+, 11 months for HR-/HER2+, and 6 months for HR-/HER2- ( < .0001). Relative to HR+/HER2- breast cancer, HR-/HER2- breast cancer was associated with a significantly higher risk of mortality among patients, and the association was stronger among patients who received chemotherapy ( for interaction = .005).
CONCLUSIONS
Breast cancer subtype significantly predicted overall survival among patients with brain metastasis at diagnosis.
背景
脑转移是乳腺癌相关死亡的重要原因。
目的
我们评估了初诊时脑转移乳腺癌患者的乳腺癌亚型与预后之间的关系。
方法
从 2010 年至 2015 年，检索监测、流行病学和最终结果数据库，以确定乳腺癌脑转移患者。多变量 Cox 比例风险模型用于确定初诊脑转移患者生存相关的因素。采用 Kaplan-Meier 法比较不同乳腺癌亚型患者的生存结局。
结果
在 752 例初诊脑转移的乳腺癌患者中，140 例（18.6%）患者行原发手术，612 例（81.4%）患者未行手术；460 例（61.2%）患者接受化疗，292 例（38.8%）患者未接受化疗。多变量分析显示，与 HR+/HER2- 乳腺癌相比，HR-/HER2- 乳腺癌的总生存显著较差（风险比：2.52，95%置信区间：1.99-3.21），独立于年龄、性别、种族、婚姻状况、保险状况、分级、肝转移、肺转移、原发手术、放疗和化疗。HR+/HER2-、HR+/HER2+、HR-/HER2+和 HR-/HER2-乳腺癌的中位总生存时间分别为 12 个月、19 个月、11 个月和 6 个月（<0.0001）。与 HR+/HER2- 乳腺癌相比，HR-/HER2- 乳腺癌患者的死亡风险显著增加，且在接受化疗的患者中这种相关性更强（交互作用 P=0.005）。
结论
乳腺癌亚型显著预测初诊脑转移乳腺癌患者的总体生存。
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