Abstract P3-12-06: Clinicopathological Analysis of Breast Cancer Patients with Brain Metastases

Abstract

Abstract Background: Recent advances in chemotherapy have enabled to control the progression of metastases from breast cancer except for the brain, highlighting the symptoms associated with brain metastases. In addition, improvement in our understanding of breast cancer biology changed the treatment strategy, possibly leading to improved outcomes in patients with breast cancer and brain metastases. Object: The aim of this study was to investigate the correlation between biology of primary tumors and prognosis of patients with breast cancer metastasis to the brain. Patients and method: Among 3,171 patients with primary breast cancer undergoing surgery at out hospital from 2003 to 2010, 35 patients (1.1%) who developed brain metastases, excluding stage IV at the initial diagnosis. We reviewed 35 patients for a correlation between survival and clinicopathological variables, including stage, hormonal sensitivity, HER2 expression status, the number of brain metastases, and treatment for brain metastases. Results: The mean age of 35 patients was 52.1 years (range 22–68) and the median follow-up period was 41.0 months. The subtypes of primary tumors included triple-negative (TN) in 14 patients (40%), luminal in 11 patients (31.4%), luminal HER2-positive (luminal HER2) in 2 patients (5.7%), and HER2-positive (HER2) in 2 patients (5.7%). The duration from surgery to recurrence (disease-free survival, DFS, months) was 14.7 in TN, 26.5 in luminal, 29.8 in luminal HER2, and 31.0 in HER2. The duration from the first recurrence to the detection of brain metastases (months) was 7.2 in TN, 14.4 in luminal, 15.8 in luminal HER2, and 4.0 in HER2. The mean survival time after the diagnosis of brain metastases was 8.6 months (range, 0–40) with a survival time of ³ 1 year in 8/35 patients (23%) and that of < 1 year in 21/35 patients (60%). Both DFS and the duration from the first recurrence to the diagnosis of brain metastases were shorter in TN compared with other subtypes. In HER2 subtype, DFS was long but, once recurrence was detected, the duration to the development of brain metastases was short. In multivariate analysis of clinicopathological variables (age, DFS, ER, HG, HER2, the number of brain metastases (solitary versus multiple), the site of initial metastasis (brain versus other organs), and the presence or absence of chemotherapy after brain metastases, revealed solitary brain metastasis (p = 0.002) and the initial metastatic site of brain (p = 0.003) to be independent factors predicting survival. Conclusion: The clinical outcomes of brain metastases were different among tumor subtypes. Factors predicting survival in patients with breast cancer and brain metastases may be the site of initial metastasis, the number of brain metastasis, and local treatment for brain metastases. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-12-06.