乳腺癌脑转移患者的临床病理特征及预后的影响因素分析

Clinical and pathological characteristics as well as prognostic analysis of breast cancer patients with brain metastases

目的·探究乳腺癌脑转移患者的临床病理特征、预后情况及可能的影响因素。方法·选择2007年1月—2021年12月于上海交通大学医学院附属仁济医院收治的女性乳腺癌脑转移患者75例。通过临床电子病历收集患者的临床病理特征,并于随访期间收集患者的脑转移后总生存期(overall survival after brain metastases,OSBM)。采用受试者操作特征曲线(receiver operating characteristic curve,ROC curve,ROC曲线)评估各项生化指标对OSBM的预测效能。采用Kaplan-Meier生存曲线分析不同临床病理特征与患者OSBM的相关性,并在此基础上对具有统计学意义的因素进一步行Cox比例风险回归分析,以确定独立影响因素。结果·75例患者的OSBM为11.0 (5.0,24.0)个月。ROC曲线的结果显示,糖类抗原125(carbohydrate antigen125,CA125)对OSBM具有较好的预测效果,其最佳截断值为22.3 U/mL。Kaplan-Meier生存分析的结果显示,初发转移为脑转移(P=0.046)、脑转移治疗期间颅外病灶发生进展(P=0.042)、脑转移灶仅累及小脑幕一侧(P=0.013)、 CA125水平<22.3 U/mL (P=0.000)、接受过局部治疗(P=0.034)改良分级预后评估(modified Graded Prognostic Assessment,mGPA)>1分(P=0.001)的患者的OSBM更长。Cox比例风险回归分析显示,脑转移灶同时累及小脑幕两侧或累及脑膜(P=0.029)、CA125水平≥22.3 U/mL (P=0.005)为OSBM的危险因素,mGPA>1分(P=0.033)为其保护因素。结论·乳腺癌脑转移灶的位置、确诊脑转移时患者的CA125水平以及mGPA评分是影响预后的重要因素。

Objective·To explore clinical and pathological characteristics, prognosis and potential related factors of breast cancer patients with brain metastases. Methods·Seventy-five female breast cancer patients with brain metastases admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2007 to December 2021 were selected. The clinical and pathological characteristics of the patients were collected through clinical electronic cases, and the overall survival after brain metastases(OSBM) of the patients was collected during the follow-up period. Receiver operating characteristic curve(ROC curve)was used to evaluate the predictive efficiency of different biochemical factors on OSBM. Kaplan-Meier survival curve was used to analyze the correlation between different clinical and pathological characteristics and patients’ OSBM. Cox proportional hazards regression analysis was further performed on statistically significant factors to determine independent influencing factors.Results·The OSBM of 75 patients was 11.0(5.0, 24.0) months. The results of ROC curve showed that carbohydrate antigen 125(CA125) had a good prediction effect on OSBM, and its best cut-off value was 22.3 U/mL. The results of Kaplan-Meier survival analysis showed that the patients whose first metastatic site was brain(P=0.046), whose extracranial disease status was progressed(P=0.042), whose brain metastasis involved one side of tentorium(P=0.013), whose CA125 level<22.3 U/mL(P=0.000), whose treatment methods incladed regional therapy(P=0.034) and whose modified Graded Prognostic Assessment(mGPA) score>1(P=0.001), had longer OSBM. Cox proportional hazards regression analysis showed that brain metastasis involving both sides of tentorium or meningeal(P=0.029), and CA125 level≥22.3 U/mL(P=0.005) were the risk factors for OSBM, and mGPA score>1(P=0.033) was the protective factor. Conclusion·The position of brain metastases in breast cancer, the level of CA125 and the mGPA score are important factors affecting the prognosis of patients.