在靶向治疗（TT）时代以及通过立体定向放射外科（SRS）和手术切除改善颅内肿瘤局部控制的情况下，乳腺癌脑转移（BCBM）患者的中位生存期有所增加。然而，对过去5年中长期生存患者的详细描述仍然很少。本文的目的是描述BCBM患者中实现长期生存的特点，并确定与独特良好预后相关的因素，从而为BCBM患者找到死亡预测因子。 我们回顾了2012年至2022年间，在我院接受SRS治疗的190名乳腺癌患者的931个脑肿瘤情况，并进行了前瞻性数据收集。我们分析了临床、分子和影像数据，评估其与预后和肿瘤控制的关系。 从初始SRS治疗和乳腺癌诊断开始的中位总生存期分别为25个月（95% CI 19-31个月）和130个月（95% CI 100-160个月）。16名患者（17%）实现了长期生存（从SRS治疗开始至少存活5年），其中9名仍然健在。长期生存的预测因子包括HER2阳性状态（P = .041）和TT治疗（P = .046）。仅有11%的患者因中枢神经系统（CNS）原因而死亡。SRS治疗后蛛网膜下腔病变的发生是CNS相关死亡的预测因子（P = .025），而非CNS死因的预测因子包括首次SRS治疗时的颅外转移（P = .017），三阴性乳腺癌（P = .002），首次SRS治疗时卡诺夫斯基绩效评分<80（P = .002），以及最后随访时存在活动性全身性疾病（P = .001）。最终只有13%的患者需要全脑放疗。在长期生存者中，没有患者因CNS进展而死亡。 BCBM患者可以实现长期生存。TT的使用和HER2阳性疾病与长期生存相关。死亡的主要原因是颅外疾病进展，而有大于等于5年生存的患者中没有人死于CNS相关疾病。 版权所有 © 2023年神经外科医生大会。保留所有权利。

Median survival for all patients with breast cancer with brain metastases (BCBMs) has increased in the era of targeted therapy (TT) and with improved local control of intracranial tumors using stereotactic radiosurgery (SRS) and surgical resection. However, detailed characterization of the patients with long-term survival in the past 5 years remains sparse. The aim of this article is to characterize patients with BCBM who achieved long-term survival and identify factors associated with the uniquely better outcomes and to find predictors of mortality for patients with BCBM.We reviewed 190 patients with breast cancer with 931 brain tumors receiving SRS who were followed at our institution with prospective data collection between 2012 and 2022. We analyzed clinical, molecular, and imaging data to assess relationship to outcomes and tumor control.The median overall survival from initial SRS and from breast cancer diagnosis was 25 months (95% CI 19-31 months) and 130 months (95% CI 100-160 months), respectively. Sixteen patients (17%) achieved long-term survival (survival ≥5 years from SRS), 9 of whom are still alive. Predictors of long-term survival included HER2+ status (P = .041) and treatment with TT (P = .046). A limited number of patients (11%) died of central nervous system (CNS) causes. A predictor of CNS-related death was the development of leptomeningeal disease after SRS (P = .025), whereas predictors of non-CNS death included extracranial metastases at first SRS (P = .017), triple-negative breast cancer (P = .002), a Karnofsky Performance Status of <80 at first SRS (P = .002), and active systemic disease at last follow-up (P = .001). Only 13% of patients eventually needed whole brain radiotherapy. Among the long-term survivors, none died of CNS progression.Patients with BCBM can achieve long-term survival. The use of TT and HER2+ disease are associated with long-term survival. The primary cause of death was extracranial disease progression, and none of the patients living ≥5 years died of CNS-related disease.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.