乳腺癌脑转移瘤立体定向放疗预后因素分析

Prognostic analysis of brain metastases from primary breast cancer treated with stereotactic radiotherapy

目的探讨乳腺癌脑转移行立体定向放疗（SRT）的预后影响因素。方法回顾分析37例行SRT的乳腺癌脑转移患者，其中首程行单纯SRT19例，首程行全脑放疗（WBRT）加SRT8例（WBRT与SRT间隔时间〈2个月），WBRT失败后行SRT挽救患者10例。Kaplan—Meier法计算生存期，Logrank法单因素预后分析，Cox模型多因素预后分析。结果全组患者中位随访时间11个月，仍生存患者中位随访时间15个月。全组中位生存期11个月（95％CI=6～16个月）。单因素预后分析显示三阴性乳腺癌（x2=5．95，P=0．004）、卡氏评分低（x2=13．85，P=0．000）、原发灶诊断至脑转移间隔时间≤30个月（X2=6．62，P=0．010）、RPA分级差（X2=15．35，P=0．000）及WBRT后复发（x2=4．43，P=0．035）是SRT预后不良因素，多因素预后分析显示三阴性乳腺癌（X2=9．58，P=0．008）、卡氏评分低（X2=6．65，P=0．010）及WBRT后复发（X2=3．95，P=0．047）是SRT预后不良因素。结论三阴性乳腺癌、卡氏评分低及WBRT后复发是乳腺癌脑转移后行SRT的预后不良因素。

Objective To explore the prognostic factors of brain metastases from primary breast cancer treated with stereotactic radiotherapy （SRT）. Methods Retrospectively analyze 37 brain metastatic patients from primary breast cancer. Among these patients nineteen were treated with stereotactic radiotherapy alone, eight patients were treated with whole brain radiotherapy （WBRT） plus SRT, the other ten patients were intracranial recurrence after WBRT and treated with SRT for salvage. Kaplan-Meier analyses were used to calculate survival time. Logrank and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses. Results The median follow-up time were 11 months and 15 months for the whole group and the alive. The median overall survival time was 11 months （95 % CI = 6- 16. month） for the whole group. The median overall survival time was 13.5 months for the whole group. In univariate analysis, the triple negative breast cancer （ X2 = 5.95, P = 0. 004）, lower Karnofsky performance score （KPS, X2= 13.85, P = 0. 000）, the interval between the diagnosis of the primary tumor and brain metastases ≤ 30 months （ X2 = 6. 62, P = 0. 010） , high RPA grade （ X2 = 15.35, P = 0. 000 ） and intracranial recurrence after whole brain radiotherapy （ X2 = 4. 43, P = 0. 035 ） were negative prognostic factors for brain metastasis of breast cancer treated with stereotactic radiotherapy. In multivariate analyses, the triple negative breast cancer （X2 = 9. 58, P = 0. 008 ）, lower KPS （ X2 = 6.65, P = 0.010 ）, and intracranial recurrence after whole brain radiotherapy （ X2 = 3. 95, P = 0. 047） were negative prognostic factor. Conclusion The triple negative breast cancer, lower KPS, and intracranial recurrence after WBRT were negative prognostic factor for brain metastasis from primary breast cancer treated with SRT.