title: Clinical features and prognostic factors in patients with carcinomatous meningitis secondary to breast cancer.
abstract: Prognosis in patients with carcinomatous meningitis (CM) is poor, and numerous prognostic factors for response and survival have been described, but remain controversial. In general, series are small and involve a heterogeneous type of solid neoplasms. The purpose of this study was to describe a series of patients with breast cancer-associated CM to determine the clinical features and prognostic factors associated with survival. We conducted a retrospective study on 49 patients diagnosed between January 2003 and December 2007 at the Instituto Nacional de Cancerología in Mexico City. CSF cytopathology samples were re-reviewed to confirm the diagnosis. Overall survival (OS) for patients with breast cancer with CM was 7 weeks. Factors independently associated with better OS included absence of encephalopathy at diagnosis (11 weeks versus 1 week; p = .036), low CSF protein content (15 versus 5 weeks; p = .022), and nontriple-negative receptor status in the primary breast cancer tumor (13 versus 3 weeks; p = .015). According to multivariate analysis, patients were divided into favorable and poor prognostic groups, with OS of 14 weeks and 2 weeks, respectively (p < .001). These factors can identify a subgroup of patients who are candidates for an intensive management approach.
authors.affiliation: Departments of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lara-Medina
authors.forename: Alejandro
authors.initials: A
authors.lastname: Crismatt
authors.forename: Cynthia
authors.initials: C
authors.lastname: Villarreal-Garza
authors.forename: Alberto
authors.initials: A
authors.lastname: Alvarado-Miranda
authors.forename: Lorena
authors.initials: L
authors.lastname: Flores-Hernández
authors.forename: Marcelino
authors.initials: M
authors.lastname: González-Pinedo
authors.forename: Carlos
authors.initials: C
authors.lastname: Gamboa-Vignolle
authors.forename: J D Salvador
authors.initials: JD
authors.lastname: Ruiz-González
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D002555:Cerebrospinal Fluid; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D055756:Meningeal Carcinomatosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013129:Spinal Puncture; D015996:Survival Rate; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab; D008727:Methotrexate