title: Prognostic significance of human epidermal growth factor receptor positivity for the development of brain metastasis after newly diagnosed breast cancer.
abstract: OBJECTIVE
  As survival in breast cancer patients is improving, brain metastases are becoming increasingly prevalent. The risk of brain metastases in newly diagnosed human epidermal growth factor receptor 2 (HER-2) -overexpressing breast cancer patients is not yet fully defined. We aimed to analyze the risk of brain metastasis in newly diagnosed HER-2-positive breast cancer patients in comparison with HER-2-negative patients.
  
  
  METHODS
  To determine the incidence of brain metastases in HER-2-overexpressing patients, we analyzed a cohort of newly diagnosed 301 HER-2-positive and 363 HER-2-negative patients identified between January 1998 and December 2003. The association between histologic features and the occurrence of brain metastases was evaluated with univariate and multivariate Cox regression analysis.
  
  
  RESULTS
  Median follow-up was 3.9 years. Brain metastases were identified in 9% (27 patients) with HER-2-overexpressing breast cancer compared with only 1.9% (7 patients) in the HER-2 negative patients (hazard ratio 4.23 [1.84-9.74], P = .0007). HER-2 overexpression, tumor size larger than 2 cm, at least one positive node, and grade 2/3 disease were predictors of brain metastases in univariate analysis. In multivariate analysis, HER-2 overexpression, tumor size larger than 2 cm, and hormone-receptor negativity were independent prognostic factors for the development of brain metastases, whereas hormone-receptor expression was protective.
  
  
  CONCLUSIONS
  Our study shows that newly diagnosed HER-2-overexpressing breast cancer patients are at increased risk for brain metastases. Because most brain metastases occur after the development of systemic disease, these findings prompt consideration of brain prophylaxis strategies with HER-2-inhibiting small molecules able to cross the blood-brain barrier and/or radiologic screening to detect asymptomatic brain metastases.
authors.affiliation: Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Gabos
authors.forename: Richie
authors.initials: R
authors.lastname: Sinha
authors.forename: John
authors.initials: J
authors.lastname: Hanson
authors.forename: Nitin
authors.initials: N
authors.lastname: Chauhan
authors.forename: Judith
authors.initials: J
authors.lastname: Hugh
authors.forename: John R
authors.initials: JR
authors.lastname: Mackey
authors.forename: Bassam
authors.initials: B
authors.lastname: Abdulkarim
mesh_terms: D001812:Blood-Brain Barrier; D001932:Brain Neoplasms / Q000517:prevention & control / Q000556:secondary*; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis* / Q000378:metabolism*; D012307:Risk Factors
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases