title: Expression of high affinity folate receptor in breast cancer brain metastasis.
abstract: High affinity folate receptor (HFR) can be overexpressed in breast cancer and is associated with poor prognosis, however the expression in breast cancer brain metastases (BCBM) is unknown. The aim of this study was to analyze the rate of HFR expression in BCBM and its role in the prognosis of this high-risk cohort. We analyzed 19 brain metastasis (BM) and 13 primary tumors (PT) from a total of 25 patients. HFR status was assessed by immunohistochemistry. Median follow-up was 4.2 years (range 0.6-18.5). HFR was positive in 4/19 BM (21.1%) and in 1/13 PT (7.7%). Positive samples had low H-scores (range 1-50). 56% of patients had apocrine differentiation. OS was similar between patients with positive HFR (median OS 48 months) and negative HFR (median OS 69 months) (P = 0.25); and between patients with apocrine differentiation (median OS 63 months) and those without apocrine differentiation (median OS 69 months) (P = 0.49). To the best of our knowledge, this is the first analysis of HFR expression in BCBM. While previous studies associated the presence of HFR with worse prognosis; in our cohort HFR was positive in only 21.1% of BM with low levels of positivity. Neither HFR nor apocrine features had impact in OS.
authors.affiliation: Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: José Pablo
authors.initials: JP
authors.lastname: Leone
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhargava
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Theisen
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hamilton
authors.affiliation: Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Lee
authors.affiliation: Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brufsky
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000737:chemistry* / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000737:chemistry* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002454:Cell Differentiation; D005260:Female; D058973:Folate Receptors, GPI-Anchored / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D058973:Folate Receptors, GPI-Anchored
keywords: brain metastasis; breast cancer; folate receptor alpha; high affinity folate receptor; metastatic breast cancer