| Background:Breast cancer is the most common cancer in women and the second most deadly cancer.Distant metastasis is an important factor affecting prognosis.Although the incidence of brain metastasis is lower than that of lung,bone and soft tissue metastasis at the metastatic site,it has the greatest impact on the survival and prognosis of patients.Although significant progress has been made in the treatment and prognosis of breast cancer,there are still some patients with poor prognosis.From the perspective of molecular typing,compared with hormone receptor-positive breast cancer and her-2 overexpressed breast cancer,tri-negative breast cancer characterized by hormone receptor-negative and her-2 negative has fewer clinical treatment options,poor treatment effect and poor prognosis.Therefore,it is often difficult to treat patients with brain metastasis associated with triple-negative breast cancer clinically.Therefore,it is of great clinical significance to study the relevant clinical characteristics and prognostic factors of patients with brain metastasis associated with triple-negative breast cancer to formulate effective treatment strategies.Objectives:To explore the clinical characteristics and prognostic factors of patients with brain metastasis of triple-negative breast cancer,so as to provide a basis for the clinical development of effective treatment strategies and improve the quality of life of patients with advanced breast cancer.Methods:Data of pathologically diagnosed women with stage Ⅳ and triple-negative breast cancer from 2010 to 2015 registered in the SEER database were retrospectively analyzed.The incidence of brain metastasis in patients with initial stage Ⅳ was calculated.Kaplan-meier method was used to compare the survival of patients with and without brain metastasis.Univariate and multivariate analyses were performed using Cox proportional risk model to analyze the clinical and pathological parameters affecting the survival of patients with stage Ⅳ triple-negative breast cancer.Then,clinical and pathological data of patients with tri-negative breast cancer with initial brain metastasis were extracted,and COX proportional risk model was used to explore the factors affecting the prognosis.Results:Among the female breast cancer patients registered in the SEER database between 2010 and 2015,a total of 29787 patients with triple negative breast cancer were screened out,including 1883 patients with stage Ⅳ,a total of 214 patients with brain metastasis at the time of diagnosis,and the incidence of brain metastasis at the time of initial diagnosis was 0.71%.The median survival was 12.0 months(95%CI: 11.3-12.7)for patients with stage Ⅳ triple negative breast cancer,with 1-year and 2-year cumulative survival rates of 49.2% and 24.7%,respectively.Multivariate survival analysis showed that primary surgery,chemotherapy and brain metastasis were independent factors affecting the prognosis of patients with stage Ⅳ triple-negative breast cancer.Compared with no operation,HR=0.507(95%CI:0.414-0.620,P=0.000);Comparison between chemotherapy and non-chemotherapy,HR=0.408(95%CI:0.320-0.520,P=0.000);Compared with no brain metastasis,HR= 2.323(95%CI:1.694-3.185,P=0.000).The median survival was 6.0 months(95% CI:4.476-7.524)in 214 patients with triple-negative breast cancer with initial brain metastasis.The 1-year cumulative survival rate was 24.8%,and the 2-year cumulative survival rate was 8.0%.Multivariate Cox regression analysis showed that age at the time of diagnosis could increase the risk of tumor-specific death in patients with brain metastasis of triple-negative breast cancer,with HR=1.499(95%CI: 1.036-2.170,P= 0.032).However,primary surgery and chemotherapy can reduce the risk of tumor-specific death in patients with brain metastases from triple-negative breast cancer: compared with unresected primary resection,HR= 0.363(95%CI: 0.220-0.598,P=0.000);Compared with non-chemotherapy,HR= 0.433(95%CI:0.260-0.721,P=0.001).Conclusions:Triple-negative breast cancer has the biological characteristics of high invasion,high histological grade,easy local recurrence and distant metastasis,and a high rate of lung,liver and brain metastasis,the median survival time of patients with brain metastasis is short,and the prognosis is very poor.The age of diagnosis may be a risk factor for the prognosis of patients,and surgery and chemotherapy at the primary site may be a protective factor for the prognosis of patients.The age of diagnosis,the presence or absence of primary site surgery and chemotherapy may have certain significance for the prognosis of patients with advanced breast cancer with brain metastasis. |
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