乳腺癌脑转移患者临床病理因素及预后分析:基于SEER数据库的回顾性研究

Analysis of clinical and pathological factors in breast cancer patients with brain metastasis: a retrospective study based on SEER database

目的分析影响乳腺癌脑转移的临床病理因素,探讨影响乳腺癌脑转移患者预后的因素。方法收集整理美国国立癌症研究所监测、流行病学和结果数据库SEER中首诊VI期乳腺癌患者4 473例,按照是否发生脑转移将患者分成脑转移组(345例)和非脑转移组(4 128例),利用χ2检验和二元Logistic回归分析影响乳腺癌脑转移的临床病理特征。选取其中临床病理资料完整的345例脑转移患者,采用Kaplan-Meier法计算OS和中位生存时间,利用Log-Rank检验进行单因素分析,将单因素分析结果中有统计学意义的因素纳入COX比例风险回归模型进行多因素分析,得到影响乳腺癌脑转移患者预后的独立危险因素。结果脑转移组相比非脑转移组,χ2检验中有统计学意义的临床病理因素包括:年龄、组织学分级、T分期、N分期、ER、PR和HER2表达水平,其中年龄、T分期、N分期、ER和PR表达水平是影响乳腺癌脑转移发生的独立影响因素。在生存分析当中,Log-Rank检验有统计学意义的因素包括:婚姻状态、组织学分级、ER、PR、分子分型、是否进行放疗和化疗、原发部位手术情况、转移部位手术情况、肝转移情况、肺转移情况和其他远处转移脏器数目。将上诉因素纳入COX比例风险回归模型,得出影响乳腺癌脑转移患者预后的独立危险因素包括:组织学分级、ER、PR、分子分型、放化疗情况、原发部位手术情况和转移部位手术情况。结论乳腺癌脑转移患者预后较差,不同分子分型的预后存在显著差异,放化疗、对原发部位和转移部位的手术可改善乳腺癌脑转移患者预后。

Objective To evaluate the impact of clinical and pathological factors on incidence and prognosis of brain metastasis from breast cancer. Methods The clinical data of 4473 stage Ⅳ breast cancer patients were collected from The Surveillance, Epidemiology, and End Results (SEER) database. All these patients were divided into brain metastasis group (n=345) and non-brain metastasis group (n=4 128). The clinical and pathological factors between the two groups were compared using χ2 test and binary Logistic regression. The OS of 345 brain metastasis patients was calculated using the Kaplan-Meier method and impact of clinical and pathological factors on the survival rate was analyzed by Log-rank method. Multivariate Cox regression model was used to find out the independent risk factors. Results Between brain metastasis group and non-brain metastasis group, these following clinical and pathological factors showed the scatistical significance on brain metastasis: age, histological grade, T stage, N stage, ER, PR and HER expression (P<0.05). Binary Logistic regression results showed that age, T stage, N stage, ER, PR were independent factors affecting brain metastasis (P<0.05). The prognosis analysis showed that marital status, histological grade, ER, PR, molecular subtype, radiotherapy and chemotherapy, surgery at primary lesions, surgery at metastasis site, liver metastasis, lung metastasis and numbers of other organs metastasis were significantly correlated with the survival of breast cancer patients with brain metastasis (P<0.05). Cox regression analysis showed that histological grade, ER, PR, molecular subtype, radiotherapy and chemotherapy, surgery at primary lesions, surgery at metastasis site were independent prognostic factors in breast cancer patients with liver metastasis. Conclusions Breast cancer patients with brain metastasis have a poor prognosis. Molecular subtype should be considered for prediction of prognosis for patients with brain metastasis. Radiotherapy and surgery at metastasis or primary site may improve survival of patients.