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目前，缺乏对乳腺癌诊断时脑转移发生率和预后进行估计的人群研究。 2017年3月16日，《美国医学会杂志肿瘤学分册》在线发表布莱根女子癌症中心、哈佛大学医学院、哈佛大学陈曾熙公共卫生学院、达纳法伯癌症研究所、布莱根女子医院、耶鲁大学公共卫生学院的大样本人群队列研究报告，对癌症诊断时乳腺癌和脑转移患者的发病比例和中位生存进行了分析，发现三阴性、HR阴性且HER2阳性亚型患者在诊断乳腺癌时的脑转移率最高（分别占任何部位远处转移病变亚组的11.37%和11.45%），三阴性病变患者预后最差（中位生存6个月），将来可能有必要开展研究评价对脑转移高风险患者进行脑磁共振筛查的效果。 该研究使用国家癌症研究所（NCI）监测、流行病学和最终结果（SEER）数据库，确定诊断时有脑转移的乳腺癌患者；按亚型、年龄、性别、种族对数据进行分层，通过多变量逻辑和Cox回归，确定诊断时存在脑转移的预测因素、全因死亡率相关因素。 对于发病率，该研究共确定了2010～2013年期间23万8726例诊断为浸润性乳腺癌成年患者的人群样本，并且知道诊断时是否存在脑转移。从生存分析排除尸检诊断或随访不详的7042例患者后，该队列剩余23万1684例患者。 主要结局指标为脑转移和新诊断乳腺癌患者的发病比例和中位生存。 结果发现，968例患者在诊断乳腺癌时有脑转移，占整个队列的0.41%，占任何部位远处转移病变亚组的7.56%。年龄为18～40、41～60、61～80、＞80岁的分别有57、423、425、63例。男性10例、女性958例。 其中，HR阴性且HER2阳性、三阴性患者的脑转移发病比例最高，分别占整个队列的1.09%、0.68%，占任何部位远处转移病变亚组的11.45%、11.37%。 整个队列脑转移者的中位生存为10.0个月。HR阳性且HER2阳性亚型患者的中位生存最长（21.0个月），HR阴性且HER2阳性、三阴性亚型患者的中位生存最短（分别为10.0、6.0个月）。 因此，该研究基于人群估计了乳腺癌诊断时脑转移的发生率和预后，该结果为考虑进行脑磁共振以筛查颅外转移的HER2阳性或三阴性亚型患者提供了依据。 JAMA Oncol. 2017 Mar 16. [Epub ahead of print] Brain Metastases in Newly Diagnosed Breast Cancer: A Population-Based Study. Martin AM, Cagney DN, Catalano PJ, Warren LE, Bellon JR, Punglia RS, Claus EB, Lee EQ, Wen PY, Haas-Kogan DA, Alexander BM, Lin NU, Aizer AA. Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard T. H. Chan School of Public Health, Dana-Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; School of Public Health, Yale University, New Haven, Connecticut; Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. QUESTION: What are the incidence and prognosis of patients with breast cancer and brain metastases at diagnosis? FINDINGS: In this population-based cohort study, patients with triple-negative and hormone receptor-negative human epidermal growth factor receptor 2-positive subtypes and metastatic disease to any distant site harbored the highest likelihood (11.37% and 11.45%, respectively) of presenting with brain metastases at diagnosis of breast cancer. The prognosis of patients with triple-negative disease was poorest (median survival, 6 months). MEANING: Future studies evaluating the utility of screening brain magnetic resonance imaging among patients at high risk of brain metastases may be warranted. IMPORTANCE: Population-based estimates of the incidence and prognosis of brain metastases at diagnosis of breast cancer are lacking. OBJECTIVE: To characterize the incidence proportions and median survivals of patients with breast cancer and brain metastases at the time of cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS: Patients with breast cancer and brain metastases at the time of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. Data were stratified by subtype, age, sex, and race. Multivariable logistic and Cox regression were performed to identify predictors of the presence of brain metastases at diagnosis and factors associated with all-cause mortality, respectively. For incidence, we identified a population-based sample of 238726 adult patients diagnosed as having invasive breast cancer between 2010 and 2013 for whom the presence or absence of brain metastases at diagnosis was known. Patients diagnosed at autopsy or with an unknown follow-up were excluded from the survival analysis, leaving 231684 patients in this cohort. MAIN OUTCOMES AND MEASURES: Incidence proportion and median survival of patients with brain metastases and newly diagnosed breast cancer. RESULTS: We identified 968 patients with brain metastases at the time of diagnosis of breast cancer, representing 0.41% of the entire cohort and 7.56% of the subset with metastatic disease to any site. A total of 57 were 18 to 40 years old, 423 were 41 to 60 years old, 425 were 61-80 years old, and 63 were older than 80 years. Ten were male and 958 were female. Incidence proportions were highest among patients with hormone receptor (HR)-negative human epidermal growth factor receptor 2 (HER2)-positive (1.1% among entire cohort, 11.5% among patients with metastatic disease to any distant site) and triple-negative (0.7% among entire cohort, 11.4% among patients with metastatic disease to any distant site) subtypes. Median survival among the entire cohort with brain metastases was 10.0 months. Patients with HR-positive HER2-positive subtype displayed the longest median survival (21.0 months); patients with triple-negative subtype had the shortest median survival (6.0 months). CONCLUSIONS AND RELEVANCE: The findings of this study provides population-based estimates of the incidence and prognosis for patients with brain metastases at time of diagnosis of breast cancer. The findings lend support to consideration of screening imaging of the brain for patients with HER2-positive or triple-negative subtypes and extracranial metastases. PMID: 28301662 DOI: 10.1001/jamaoncol.2017.0001
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