乳腺癌脑转移立体定向放射外科手术后全身性疾病对中枢神经系统疾病控制的影响（SYBRA 研究）。
Impact of systemic disease on CNS disease control after stereotactic radiosurgery to breast cancer brain metastases (The SYBRA Study).
发表日期：2024 Aug 02
作者：
Alex Schick, Sara Hardy, Myla Strawderman, Dandan Zheng, Michael Cummings, Michael T Milano, Allison Magnuson, Jacqueline Behr, Sarah Sammons, Kenneth Usuki, Nimish Mohile, Ruth O'Regan, Carey K Anders, David Hicks, Ajay Dhakal
来源：
npj Breast Cancer
摘要：
该研究的目的是评估全身性疾病 (SD) 状态对总体生存和脑转移 (BM) 控制的影响，采用一种新颖的里程碑式方法对乳腺癌 (BC) 患者中的 SD 进行分类。这项单一机构回顾性研究纳入了接受过脑部立体定向放射外科 (SRS) 治疗的 BCBM 患者。对每个地标 (LM) 的单独终点 [CNS 无故障生存 (cFFS)、总生存 (OS)] 进行分析：LM1（3 个月）、LM2（6 个月）。根据 LM 之前的 SD 状态，将患者分为早期进展和非早期进展 (EP、NEP) 组。 LM 的中位生存期通过 Kaplan Meier 图进行评估，并与 Log-Rank 检验进行比较。在两项 LM 分析中，与 NEP 相比，EP 与较差的中位 cFFS 和 OS 相关（cFFS-LM1：3.6 个月与 9.7 个月，p = 0.0016；LM2：2.3 个月与 12.5 个月，p< 0.0001；OS-LM1：3.6 个月与 24.3个月，p < 0.0001；LM2：5.3 与 30.2 个月，p < 0.0001）。在多变量分析中，EP 与较短的 cFFS 相关 [LM1：风险比 (HR)，95% 置信区间 (CI) 3.16、1.46-6.83，p = 0.0034； LM2：5.32、2.33-12.15，p = <0.0001] 和更短的 OS（LM1：HR 95% CI 4.28、1.98-9.12，p = 0.0002；LM2：7.40、3.10-17.63，p = <0.0001）新经济政策。第一次脑部 SRS 后的早期全身性疾病进展与 BCBM 患者的 cFFS 和 OS 较差相关。© 2024。作者。
The objective of the study is to assess impact of systemic disease (SD) status on overall survival and brain metastasis (BM) control, adopting a novel landmark approach to categorize SD among breast cancer (BC) patients. This single institution retrospective study included BCBM patients who have received stereotactic radiosurgery (SRS) to brain. Separate endpoints [CNS failure-free survival (cFFS), overall survival (OS)] were analyzed from each Landmark (LM): LM1 (3-months), LM2 (6-months). Patients were categorized into early and non-early progression (EP, NEP) groups depending on SD status before LMs. Median survivals from LM were assessed with Kaplan Meier plots, compared with Log-Rank test. EP was associated with worse median cFFS and OS vs NEP in both LM analyses (cFFS- LM1: 3.6 vs. 9.7 months, p = 0.0016; LM2: 2.3 vs. 12.5 months, p < 0.0001; OS- LM1: 3.6 vs. 24.3 months, p < 0.0001; LM2: 5.3 vs. 30.2 months, p < 0.0001). In multivariate analyses, EP was associated with shorter cFFS [LM1: Hazard Ratio (HR) with 95% confidence interval (CI) 3.16, 1.46-6.83, p = 0.0034; LM2: 5.32, 2.33-12.15, p = <0.0001] and shorter OS (LM1: HR with 95% CI 4.28, 1.98-9.12, p = 0.0002; LM2: 7.40, 3.10-17.63, p = <0.0001) vs NEP. Early systemic disease progressions after 1st SRS to brain is associated with worse cFFS and OS in patients with BCBM.© 2024. The Author(s).