乳腺癌脑转移预后风险分析  

Breast cancer brain metastases:Clinical characteristics and prognosis

作　　者：张冬[1] 乔京京[1] 李曼[1] 赵金波[1] 

机构地区：[1]大连医科大学附属第二医院肿瘤二科,辽宁大连116027

出　　处：《现代肿瘤医学》2017年第7期1073-1077,共5页Journal of Modern Oncology

摘　　要：目的:分析乳腺癌脑转移患者的预后危险因素,选择最佳治疗方案。方法:记录从2003年1月1日至2011年1月1日大连医科大学附属第二医院收治的共计64例明确诊断为乳腺癌脑转移患者的临床病例资料,通过Kaplan-Meier法行生存分析,筛选影响患者生存时间的单因素及Cox多因素回归分析影响患者脑转移的独立预后因素。结果:Luminal型、HER2过表达型和TNBC型患者中位总生存时间分别是52、37、21个月,中位脑转移发展时间分别是31、28、18个月,脑转移后中位生存时间分别是12、6、4个月,差异均有统计学意义。治疗方法上全脑放射治疗、内分泌治疗可明显延长脑转移患者中位生存时间(P=0.002和P=0.027)。接受联合治疗的患者中位生存时间大于单一治疗者(P=0.045)。HER2过表达的患者,脑转移前后接受赫塞汀治疗均可获益。多因素分析显示:组织学分级、首发脑转移均与预后负相关;KPS评分、放疗、内分泌治疗以及联合治疗和预后正相关。结论:组织学分级、KPS评分、首发脑转移、脑部放疗、内分泌治疗以及联合治疗均是影响乳腺癌脑转移的独立预后因素。建议选择以全脑放疗为主的联合治疗。HER2过表达的患者建议选择靶向治疗。Objective：To analyze the prognosis risk factors of breast cancer patients with brain metastases（ BM）,and to choose the best treatment plan. Methods：From January 1,2003 to January 1,2011,we collected the data of 64 patients who had been diagnosed definitely as brain metastases of breast cancer and hospitalized in the second hospital of Dalian medical university. Survival analysis was performed on three subtypes（ Luminal,HER2 and TNBC） of breast cancer patients with brain metastasis by Kaplan- Meier method. At last applying Cox multivariate regression analysis of independent prognostic factors of patients with brain metastasis. Results：The total medium survival time of the above three types were respectively 52 months,37 months and 21 months. The development time of medium brain metastases were 31 months,28 months and 18 months. The median survival time after brain metastases of the above three subtypes are 12 months,6 month and 4 months. The difference was statistical significance（ P 0. 01）. The median survival time of patients who received whole brain radiation therapy（ P = 0. 002） or endocrine therapy（ P =0. 027） was longer. The effect of combination therapy was good than single therapy（ P = 0. 045）. The HER2 over expression patients who received Herceptins before and after brain metastasis obtain a benefit. Multivariate analysis showed that histological grade and initial brain metases were negatively to the prognosis. KPS score,radiotherapy,endocrine therapy and combined therapy were positively related to the prognosis. Conclusion：Multivariate analysis showed that histological grade,KPS score,initial brain metastases,brain radiotherapy,endocrine therapy,and combined therapy are independent factors of brain metastase prognosis. It was advised the patients whole brain metastases from breast cancer should choose the combination therapeutic method. HER2 over expression patients were recommended to accept Herceptin treatment.

关 键 词：乳腺肿瘤 肿瘤转移 脑 分子分型 临床特点 预后 

分 类 号：R737.9[医药卫生—肿瘤]