乳腺癌脑转移放疗的临床疗效和预后分析

Prognosis Factors and Clinic Characteristics of Breast Cancer Patients with Brain Metastases Treated with Radiation

目的观察乳腺癌脑转移的放疗效果,探讨预后相关因素。方法对接受全脑放疗的56例乳腺癌脑转移病例进行回顾性分析,所有患者均接受全颅放疗,放疗剂量为30 Gy/10Fx。采用Kaplan-Meier法计算总生存和中位生存时间,利用COX比例风险回归模型进行多因素分析患者预后的独立危险因素。结果确诊乳腺癌脑转移平均年龄为57.9岁(32~82岁),平均随访时间为28.4个月(95%CI:11.6,49.2)。乳腺癌脑转移放疗患者中位生存时间为12.1个月(95%CI:8.7,15.5),1、2年生存率分别为52.6%、26.1%。单因素分析显示:有统计学意义的因素包括GPA评分、无颅外转移、脑转移时KPS评分、是否幕下转移、Her-2表达状态、分子分型、是否肺转移、脑转移放疗后化疗。多因素分析显示:脑转移时KPS(P=0.027)、GPA评分(P=0.036)、分子分型(P=0.042)、无颅外转移(P=0.028)、无肺转移(P=0.002)、脑转移放疗后接受化疗(P=0.034)是乳腺癌脑转移放疗患者预后的独立预后因素。结论分子分型可作为乳腺癌脑转移的预后指标。脑转移放疗后化疗、无颅外转移、高GPA评分、高KPS评分的乳腺癌脑转移放疗患者预后更好。

Objective To evaluate the impact of clinical and prognosis of breast cancer with brain metastases(BCBM)after radiotherapy.Methods 56 BCBM patients were reviewed retrospectively.All these patients received whole brain radiotherapy(WBRT).Radiotherapy was delivered with a dose of 30 Gy in 10 fractions.The overall survival(OS)was calculated using the Kaplan-Meier method,multivariate cox regression model was used to find out the independent risk factors.Results Mean age at the radiotherapy of BMs was 57.9 years(32~82 years).The mean follow-up for all patients was 28.4 months(95%CI:11.6,49.2).Median OS of BCBM patients was 12.1 months(95%CI:8.7,15.5),1-y,2-y OS were 52.6%,26.1%,respectively.The univariate analysis showed that GPA scores,extra-cranial metastasis,KPS at the diagnosis of BM,infratentorial involvement,Her-2 status,the molecular sub-type,lung metastasis,sequential chemo-radiotherapy of brain metastases were significantly correlated with the survival of BCBM patients(P<0.05).Cox regression analysis showed that KPS scores at the diagnosis of BM(P=0.027),GPA scores(P=0.036),molecular sub-type(P=0.042),without extra-cranial metastases(P=0.028),without lung metastases(P=0.002),sequential chemo-radiotherapy of BM(P=0.034)were independent prognostic factors in BCBM patients(P<0.05).Conclusion Molecular sub-type should be considered for a prediction of prognosis for patients with brain metastasis.Sequential chemo-radiotherapy after brain metastases,without extra-cranial metastases,higher GPA scores and KPS scores are associated with better survival of BCBM patients who received WBRT.