Background:Breast cancer patients who develop brain metastases have a high mortality rate and a massive decrease in quality of life. Approximately 10–15% of all patients with breast cancer (BC) and 5–40% of all patients with metastatic BC develop brain metastasis (BM) during the course of the disease. However, there is only limited knowledge about prognostic factors in the treatment of patients with brain metastases in breast cancer (BMBC). Therefore, we retrospectively analyzed data of BMBC patients from the University Hospital of Würzburg for treatment patterns to find characteristics associated with a better or worse prognosis. These findings should help to treat the ever-increasing collective of patients with BMBC better in the future.Methods:The clinical data of 337 patients with cerebral metastatic breast cancer (date of death between 2004 and 2021) treated at the Department of Gynecology and Obstetrics of the University Hospital Würzburg were retrospectively analyzed, with a focus on patients’ survival.Results:The involvement of regional lymph nodes at initial diagnosis, the immunohistochemical subtype of TNBC at the onset of BMBC, and extracranial metastases at the time of BM diagnosis (bone, liver, lung metastases) were associated with a worse prognosis. In contrast, the immunohistochemical subtype of HER2/neu, the sole occurrence of a singular BM, the local surgical removal of BMs, and radiotherapy (especially stereotactic radiotherapy) were associated with prolonged survival. The number of therapies before the diagnosis of BMs also had a prognostic influence.Conclusions:Looking back at data is crucial for pinpointing risk elements affecting survival after a BM diagnosis. In our investigation, along with established factors like immunohistologic subtype, BM count, surgical excision, stereotactic irradiation, and type of extracranial metastasis, we also found that the number of therapies before BM diagnosis and the initial lymph node status were associated with patients’ survival. Potentially, these factors could be included in prospective prognostic scores for evaluating brain metastasis survival rates, thereby aiding in making appropriate treatment suggestions for impacted patients.
背景：发生脑转移的乳腺癌患者死亡率高，生活质量显著下降。在所有乳腺癌患者中，约10-15%会发生脑转移，而在转移性乳腺癌患者中，这一比例高达5-40%。然而，目前对乳腺癌脑转移患者治疗预后因素的了解仍十分有限。为此，我们回顾性分析了维尔茨堡大学医院收治的乳腺癌脑转移患者的临床资料，旨在探索与预后相关的临床特征，以期为日益增长的乳腺癌脑转移患者群体提供更优化的治疗策略。 方法：本研究回顾性分析了2004年至2021年间在维尔茨堡大学医院妇产科接受治疗的337例脑转移乳腺癌患者的临床资料（死亡日期在此区间），重点关注患者的生存状况。 结果：研究发现，初诊时区域淋巴结受累、脑转移发生时三阴性乳腺癌的免疫组化亚型以及脑转移诊断时合并颅外转移（骨、肝、肺转移）与不良预后相关。相反，HER2/neu免疫组化亚型、单发脑转移灶、脑转移灶局部手术切除以及放射治疗（特别是立体定向放疗）与生存期延长相关。此外，脑转移诊断前的治疗次数也对预后具有影响。 结论：回顾性数据分析对于明确影响脑转移诊断后生存的风险因素至关重要。本研究不仅证实了免疫组化亚型、脑转移数量、手术切除、立体定向放疗和颅外转移类型等已知预后因素，还发现脑转移诊断前的治疗次数及初始淋巴结状态与患者生存相关。这些因素有望纳入前瞻性预后评分系统，用于评估脑转移患者的生存率，从而为临床制定个体化治疗方案提供依据。
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