不同分子亚型乳腺癌脑转移患者的临床特征和预后分析  

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

作　　者：黄州 孙冰[2] 吴世凯[2] 孟祥颖[2] 江泽飞[3] 申戈[2] 宋三泰[3] 

机构地区：[1]中南大学湘雅三医院,长沙410013 [2]军事医学科学院附属医院放疗科,北京100071 [3]军事医学科学院附属医院乳腺肿瘤科,北京100071

出　　处：《中国肿瘤临床与康复》2014年第7期769-773,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：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。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.

关 键 词：乳腺肿瘤 分子亚型 脑转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]