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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 features and prognosis of patients with different subtypes of breast cancer with brain metastases (BCBM). Methods The clinical data of 201 patients with BCBM were collected. According to the expression of primary tumor hormone receptor and epidermal growth factor receptor 2 (HER-2), the patients were divided into three subtypes of different molecular subtypes and analyzed different subtypes of BCBM patients The clinical features and survival. Results Among the 201 patients, 68 (33.8%) were Luminal, 87 (43.3%) were HER-2 and 46 (22.9%) were triple-negative. The initial sites of metastases were 68 (33.8%) lungs, 63 (31.3%) bones, 52 (25.9%) liver and 27 (13.4%) brain lesions. The incidence of bone metastasis was the highest in Luminal type (41.2%), the incidence of HER-2 type liver metastasis was 35.6%, and the incidence of brain metastases in triple-negative type 30.4%. The patients with different subtypes had the first relapse to TTBM, the different Luminal type was 18.1 months, the HER-2 type was 16.8 months, and the triple-negative type was 8.3 months, the difference was statistically significant (P = 0.005) The overall survival time was 95.7 months in Luminal patients, 72.2 months in HER-2 patients and 41.6 months in triple-negative patients. The difference was statistically significant (P = 0.002). HERB-2 patients treated with anti-HER-2 had a TTBM of 21.9 months prior to brain metastases, significantly longer than TTBM (7.2 months) without anti-HER-2 therapy (P = 0.002). Conclusion Lung, bone, liver and brain are the most common sites of distant metastases in breast cancer. Patients with triple-negative breast cancer are prone to brain metastases with the worst prognosis. Patients with triple-negative and HER-2-type without anti-HER-2 treatment are prone to early brain metastases, and anti-HER-2 therapy can delay brain metastases.