title: Impact of triple-negative phenotype on prognosis of patients with breast cancer brain metastases.
abstract: OBJECTIVE
  To elucidate survival times and identify potential prognostic factors in patients with triple-negative (TN) phenotype who harbored brain metastases arising from breast cancer and who underwent stereotactic radiosurgery (SRS).
  
  
  METHODS
  A total of 103 breast cancer patients with brain metastases were treated with SRS and then studied retrospectively. Twenty-four patients (23.3%) were TN. Survival times were estimated using the Kaplan-Meier method, with a log-rank test computing the survival time difference between groups. Univariate and multivariate analyses to predict potential prognostic factors were performed using a Cox proportional hazard regression model.
  
  
  RESULTS
  The presence of TN phenotype was associated with worse survival times, including overall survival after the diagnosis of primary breast cancer (43 months vs. 82 months), neurologic survival after the diagnosis of intracranial metastases, and radiosurgical survival after SRS, with median survival times being 13 months vs. 25 months and 6 months vs. 16 months, respectively (p < 0.002 in all three comparisons). On multivariate analysis, radiosurgical survival benefit was associated with non-TN status and lower recursive partitioning analysis class at the initial SRS.
  
  
  CONCLUSIONS
  The TN phenotype represents a significant adverse prognostic factor with respect to overall survival, neurologic survival, and radiosurgical survival in breast cancer patients with intracranial metastasis. Recursive partitioning analysis class also served as an important and independent prognostic factor.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.forename: David
authors.initials: D
authors.lastname: Schlesinger
authors.forename: Sushila
authors.initials: S
authors.lastname: Toulmin
authors.forename: Tyvin
authors.initials: T
authors.lastname: Rich
authors.forename: Jason
authors.initials: J
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000737:chemistry* / Q000473:pathology; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D016634:Radiosurgery / Q000401:mortality; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone