炎性乳腺癌脑转移患者生存结局
编者按：炎性乳腺癌（IBC）的临床表现酷似急性炎症，乳腺弥漫增大、乳腺皮肤红肿热痛，容易被误诊为急性乳腺炎。约50%的IBC摸不到肿块，经过病理检查才被确诊为乳腺癌，多数患者诊断时已经发现淋巴结转移，且与中枢神经系统（CNS）转移高风险和预后不良密切相关，但是IBC与非炎性乳腺导管浸润癌（NI-IDC）相比，发生CNS转移后的生存结局尚不明确。
2018年3月26日，美国癌症学会《癌症》在线发表德克萨斯大学门罗·邓韦·安德森癌症中心的IBC患者与NI-IDC患者最大样本分期匹配队列回顾，发现IBC患者CNS转移累积发生率较高，但是CNS转移发生后的总生存相似，HER2状态和年龄可能预后。
该回顾研究对1984年1月1日～2011年12月31日接受治疗的589例III期IBC患者与1734例NI-IDC患者进行比较分析，这些患者被诊断后1年内开始初次治疗，死亡或CNS转移发生之前接受至少1年随访，通过生存曲线计算累积CNS转移发生率和CNS转移后总生存推算值，通过多因素比例风险回归模型探讨CNS转移后生存的影响因素。
结果发现，中位随访7.2年（1～21年）期间CNS转移患者死亡190例。
IBC与NI-IDC患者相比，CNS转移发生率显著较高（P=0.0037）、总生存相似（P=0.49）
总的累积CNS转移发生率：13.6%、 8.9%
两年累积CNS转移发生率： 9.8%、 6.5%
五年累积CNS转移发生率：15.8%、10.1%
十年累积CNS转移发生率：17.4%、12.7%
CNS转移后中位总生存：7.6、5.6个月（死亡风险比：0.89，95%置信区间：0.64～1.24，P=0.49）
根据多因素（年龄、种族、绝经状态、肿瘤分级、淋巴浸润、血管浸润、雌激素受体、孕激素受体、HER2、淋巴结分期、最终手术、术后激素治疗、术前放疗、术后放疗、术前蒽环类化疗、术后蒽环类化疗、术前紫杉类化疗、术后紫杉类化疗）竞争风险回归模型分析，上述影响因素对于IBC与NI-IDC患者发生CNS转移的风险无统计学显著相关性，除了术前紫杉类化疗可使NI-IDC患者CNS转移风险低55%（风险比：0.45，95%置信区间：0.24～0.83，P=0.011）。
HER2阳性与阴性患者相比，CNS转移后总生存较好（中位总生存：14.1比4.3个月），死亡风险减少60%（风险比：0.4，95%置信区间：1.1～2.2，P＜0.0001）。
年龄＞50岁与≤50岁相比，CNS转移后总生存较差，死亡风险增加50%（风险比：1.5，95%置信区间：1.1～2.2，P=0.012），且与是否IBC无关。
因此，IBC与NI-IDC相比，患者的CNS转移发生率较高，但是CNS转移后的总生存相似，年龄和HER2状态可能发挥预后作用。
Cancer. 2018 Mar 26. [Epub ahead of print]
Development of CNS metastases and survival in patients with inflammatory breast cancer.
Marc I. Uemura, John T. French, Kenneth. R. Hess, Diane Liu MS Kanwal Raghav, Gabriel N. Hortobagyi, Banu K. Arun, Vicente Valero, Naoto T. Ueno, Ricardo H. Alvarez, Wendy. A. Woodward, Bisrat G. Debeb, Stacy L. Moulder, Bora Lim, Debu Tripathy, Nuhad K. Ibrahim.
The University of Texas MD Anderson Cancer Center, Houston, Texas.
The largest review of a staged matched cohort of inflammatory breast cancer (IBC) patients versus noninflammatory invasive ductal carcinoma patients reveals that IBC patients have a higher cumulative incidence of central nervous system (CNS) metastases but similar overall survival after CNS metastases development. HER2 status and age may be prognostic.
BACKGROUND: Inflammatory breast cancer (IBC) is associated with a poor prognosis and high risk of central nervous system (CNS) metastases.
METHODS: We retrospectively reviewed stage III-IBC patients compared with noninflammatory invasive ductal carcinoma (NI-IDC) patients treated between January 1, 1984, and December 31, 2011, who began primary treatment within 1 year of diagnosis and had been followed up for at least 1 year before the development of CNS metastasis or death. Cumulative CNS metastasis incidence and post-CNS metastasis overall survival (OS) estimates were computed. Multivariable Cox proportional hazard models explored factors for post-CNS metastasis survival.
RESULTS: A total of 2323 patients were identified (589-IBC/1734-NI-IDC). Eighty-one IBC patients developed CNS metastasis, versus 154 NI-IDC patients. The 2-, 5-, and 10-year cumulative CNS metastasis incidence rates in IBC and NI-IDC were 9.8%, 15.8%, 17.4% and 6.5%, 10.1%, and 12.7%, respectively. This was significantly different between IBC and NI-IDC patients (P = .0037). Multicovariate competing risk regression models in IBC and NI-IDC patients showed no statistically significant associations with the risk of developing CNS metastasis, except neoadjuvant taxane use in NI-IDC patients (hazard ratio, 0.45; 95% confidence interval, 0.24-0.83; P = .011). The median follow-up was 7.2 years, and the median post-CNS metastasis OS was not significantly different between IBC (7.6 months) and NI-IDC (5.6 months) patients. One hundred ninety patients with CNS metastasis died. HER2-positive patients had better OS, with a median 14.1 versus 4.3 months (P < .0001). Age >50 years (P = .012) but not IBC status was a significant predictor of post-CNS metastasis survival.
CONCLUSION: IBC patients demonstrated higher CNS metastasis incidence rates but OS following CNS metastases is similar in both groups. HER2 status and age may play prognostic roles.
DOI: 10.1002/cncr.31336