The clinicopathological evaluation of the breast cancer patients with brain metastases: predictors of survival.
We aimed to define the clinicopathologic characteristics of breast cancer (BC) patients with brain metastasis (BM) and to investigate the effect of these parameters on survival. Seventy-nine patients diagnosed with BC and symptomatic BM between 1995 and 2011 were retrospectively evaluated. The relationship between clinicopathological features and outcome was investigated. Triple negative patients had the shortest overall survival (OS) while HR(+)HER2(-) patients had the longest (48.2  vs 88.2 months, 95 % CI; p = 0.33). Multivariate analysis demonstrated that luminal A subtype was the strongest positive predictor of prolonged OS (HR 0.48, 95 % CI 0.28-0.84; p = 0.01), while poor performance status (PS) (ECOG 3-4) at BM was the strongest predictor of shortened OS (HR 1.92, 95 % CI 1.21-3.06; p = 0.006). The patients with early-stage BC at diagnosis had BM later than the advanced-staged patients (47 months for Stage I-II disease, 23.2 months for Stage III-IV disease, 95 % CI; p = 0.002). Median survival after BM was 10.2 months (6.4-14 months, 95 % CI). The patients with liver or skin metastases had significantly shorter survival than the patients with only BM (4.8 vs 17 months, p < 0.001 for liver and 4.8 vs 11.1 months, p = 0.04 for skin). Multivariate analysis demonstrated that regardless of the BC subtype, lack of systemic therapy, and liver involvement were independent factors associated with increased risk of death (HR 4, 95 % CI 1.7-9.1; p = 0.001 and HR 2.2, 95 % CI 1.05-4.9; p = 0.036 respectively). Clinical outcome after BM mostly depends on the ECOG PS and the fact that whether the patient received systemic therapy or not. Systemic therapy prolongs survival especially in HER2 positive patients.
Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin Sitesi, Karabaglar, Izmir, Turkey.
Mustafa Oktay
MO
Tarhan
Lutfiye
L
Demir
Isil
I
Somali
Seyran
S
Yigit
Cigdem
C
Erten
Ahmet
A
Alacacioglu
Hulya
H
Ellidokuz
Ozgur
O
Seseogullari
Yuksel
Y
Kucukzeybek
Alper
A
Can
Ahmet
A
Dirican
Vedat
V
Bayoglu
Murat
M
Akyol
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018276:Carcinoma, Medullary / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D015996:Survival Rate
D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone