Survival of breast cancer patients with synchronous or metachronous central nervous system metastases.
BACKGROUND
Central nervous system (CNS) metastases represent a devastating complication for advanced breast cancer patients. This observational study examines the influence of patient, tumour and treatment characteristics on overall survival after synchronous or metachronous CNS metastases.


METHODS
Information on 992 breast cancer patients with CNS metastases (whose primary tumour was diagnosed between 2004 and 2010) was retrieved from the Netherlands Cancer Registry (NCR). Overall survival was calculated from the date of CNS metastatic diagnosis, and the impact of prognostic factors on survival was assessed using univariate and multivariate extended Cox-regression models.


RESULTS
We identified 165 patients with synchronous and 827 patients with metachronous CNS metastases. The majority of patients (88%) presented with brain metastases only, 12% had leptomeningeal metastases. Overall median survival was 5.0 months. Non-triple-negative breast cancer and systemic therapy were associated with improved survival in both groups. In patients with synchronous CNS metastases, surgery for the primary tumour and the metastases also improved survival. In patients with metachronous metastases, younger age (<50 years), lower initial tumour stage (I), ductal carcinoma, a prolonged time interval until diagnosis of CNS metastasis (>1 year), and absence of extracranial metastases were associated with improved survival. Metastasectomy and radiation therapy did not provide benefit beyond the first six months.


CONCLUSIONS
No difference in survival was established between synchronous and metachronous CNS metastases. Triple-negative disease is prognostically unfavourable in both groups, while those receiving treatment have a better outcome. Metastasectomy and radiotherapy improve survival within the first six months, and additional benefit may be derived from systemic therapy.
Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB Utrecht, The Netherlands. Electronic address: v.ho@iknl.nl.
V K Y
VK
Ho
Department of Neurology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J M M
JM
Gijtenbeek
Department of Neuro-oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
D
D
Brandsma
Department of Internal Medicine, St Elisabeth Hospital, P.O. Box 90151, 5000 LC Tilburg, The Netherlands.
L V
LV
Beerepoot
Department of Medical Oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
G S
GS
Sonke
Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), P.O. Box 19079, 3501 DB Utrecht, The Netherlands.
M
M
van der Heiden-van der Loo
D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D016019:Survival Analysis
Brain metastases; Breast cancer; Central nervous system; Prognostic factors; Survival