| Breast cancer is one of the most common malignant tumors in women. accounting for 7% -10% in a variety of malignant tumors in China, with the efficacy of systemic treatment of breast cancer increased, the emergence of new drugs, to extend the survival period, brain metastasis of breast cancer are becoming more common, about 30% of breast cancer patients with brain metastases. The efficacy of brain metastases treatment is poor, prognosis is poor too, and how to forecast brain metastases bases on clinical pathology and treat timely is one of the focuses in breast cancer treatment in recent years. On this issue, 520 cases of patient with breast cancer in our hospital were retrospectively analyzed in this article.Objective: To investigate the risk factors of brain metastasis in breast cancer and provide clinical basis for the forecast.Methods: Input the data of 520 cases of hospital-patient in breast cancer with more complete information to the Excel, use of SAS (version 8.0) statistical package for Log-rank test for univariate analysis, analysis the associated-factors between breast cancer and brain metastasis ;apply COX regression model to understand the impact of breast cancer brain metastases in multiple factor analysis .Comparison of factors between Brain metastasis group and non-brain metastases group with chi-square test and t test; correlation among risk factors using chi-square test. Apply life table method to calculate the time of brain metastases in half of the cases.Results:1 Comparison in the distribution of inter-group factors between Brain metastasis group and non-brain metastasesThere were 48 cases of brain metastases in the whole group, the transfer rate was 9.23% (48/520). the median age of 48 cases of brain metastasis was 45.23 years old, non-brain metastasis group was 54.99 years old, there was significantly different (p <0.01), indicating that the lower age-prone incline to occure brain metastases.Brain metastases and HER-2 Correlation analysis showed that among 48 cases of brain metastases 23 cases for HER-2 positive, the positive rate was 47.9%.472 cases of non-brain metastases ,A total of 125 cases for HER-2 positive, the positive rate was 26.4 %, significantly lower than that of brain metastasis group(p = 0.002), prompted HER-2 positive have a higher metastatic potential.19 cases of patients with ER-negative in 48 cases of brain metastases (39.6%), significantly higher than the rate of ER-negative in non-brain metastasis group (25.21%, 119/472), there was a significant difference between the two group (p = 0.032), showed that ER-negative patients with brain metastases easily.Infiltrating ductal carcinoma was the main pathological type in both brain metastasis group and non-brain metastases, respectively, 56.3% (27/48), 60.17% (284/472), but the pathological types and brain metastases had no significant correlation (p> 0.05) .2 The time half of brain metastasesApplication of life table method to calculate the time half of brain metastases was 78.0 months, showed that78 months after the surgery ,50% breast cancer patients (95% CI -88.0 to 72.0) occured brain metastases.3 Results of single factor analysis in various factors on the impact of breast cancer brain metastasesLog-rank test analysis the factors on the impact of breast cancer brain metastases, showed that the pathological types (P <0.01), HER-2 (P <0.01) impact brain metastases from breast cancer.4 COX regression analysis4.1 Input factors to the analysis model of COXTo incorporate factors into the COX model had the follow results, the regression coefficient for age was -0.073, indicating that age was a factor in the protection of brain metastases, The younger was prone to occure brain metastases (p <0.05). Regression coefficients in Pathological types of sub-variables analysis of X2 (1) infiltrating ductal carcinoma, X2 (2) cancer alone, X2 (3) mixed cancer were greater than 1, indicating that they were risk factors for brain metastases in breast cancer (p <0.05) . X5's regression coefficient was 1.766, the relative risk was 5.845, suggesting that probability of occurring brain metastases for HER-2 positive was significantly higher (p <0.05). The regression coefficient of X3 was -0.228, the relative risk was 0.796, showing that ER-positive had low probability of brain metastases (p> 0.05). The regression coefficient of X6 was 0.559, 1.748 for the risk, suggesting that axillary lymph node metastasis of breast cancer may increase the risk of brain metastases (p> 0.05). The regression coefficient of X4 was 0.057, 1.059 for the risk of showing impact of PR on the brain metastases was not significant (p> 0.05).4.2 COX regression analysis modelSet up the COX stepwise regression model analysis (selection criteria p≤0.05). The results showed that age, HER-2, the impact of histological types of breast cancer were independent factors in brain metastases. HER-2 in which the relative risk up to 5.674, regression coefficient was 1.736, was the most significant risk factors of breast cancer brain metastases. The relative risk for age was 0.930, less than 1, suggesting that it was more difficult for the older to occure brain metastasis. Regression coefficient and Risk Values of Pathological subtypes were greater than 1, showed that patients with invasive ductal carcinoma, carcinoma simplex, mixed cancer compared with other pathological types ,the risk of the occurrence of brain metastases was higher.5 Risk factor analysis of inter-related5.1 Overall analysisIn this study, 311 cases of breast cancer with invasive ductal carcinoma in 520 cases, of which HER-2 positive 105 cases, accounting for patients with invasive ductal carcinoma of the 33.76% (105/311). In HER-2 and pathological types of correlation in the chi-square test p = 0.010, the difference was significant, invasive ductal carcinoma of the breast cancer patients with HER-2 positive have high probability. HER-2 and ER, PR, axillary lymph nodes had no correlation (all p> 0.05).5.2 Analysis of brain metastases groupIn 48 cases of breast cancer brain metastases with invasive ductal carcinoma in 27 cases, 27 cases of 19 cases (70.40%) HER-2 positive; there were correlation between the pathological type and HER-2 (p = 0.003) , suggesting that the pathological type of invasive ductal carcinoma with HER-2 high expression of brain metastases occured more easily. Correlations among other factors have no statistical significance.Conclusion: HER-2 over-expression, a relatively young age, pathological type was invasive ductal carcinoma, simple carcinoma, mixed carcinoma, should be alert to the occurrence of brain metastases. Invasive ductal carcinoma with high expression of HER-2 was more susceptible to brain metastases. Patients with breast cancer after surgey about six years and a half should be alert to the occurrence of brain metastases. With the deepening of the study, predictive factors for brain metastases from breast cancer would be more clearly,which can provide a new basis for early diagnosis and early intervention... |
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