Abstract
To evaluate the prognostic factors and indexes of a series of 93 patients with breast cancer and brain metastases (BM) in a single institution. Treatment outcomes were evaluated according to the major prognostic indexes (RPA, BSBM, GPA scores) and breast cancer subtypes. Independent prognostic factors for overall survival (OS) were identified. The median OS values according to GPA 0–1, 1.5–2, 2.5–3 and 3.5–4, were 4.5, 9.5, 14.2 and 19.1 months, respectively (p < 0.0001) and according to genetic subtypes, they were 5, 14.2, 16.5 and 17.1 months for basal-like, luminal A and B and HER, respectively (p = 0.04). Using multivariate analysis, we established a new grading system using the six factors that were identified as indicators of longer survival: age under 60 (p = 0.001), high KPS (p = 0.007), primary tumor control (p = 0.05), low number of extracranial metastases and BM (p = 0.01 and 0.0002, respectively) and triple negative subtype (p = 0.002). Three groups with significantly different median survival times were identified: 4.1, 9.5 and 26.3 months, respectively (p < 0.0001). Our new grading system shows that prognostic indexes could be improved by using more levels of classification and confirms the strength of biological prognostic factors.
Highlights
Breast cancer has the second highest rate of brain metastases (BM) (30%) after lung cancer (34%) [1,2,3,4]
The incidence of BM is high in human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer both due to the increased incidence of extracranial metastases, as well as to the effect of HER2+ tumor cells, which may have a marked brain tropism [11,12]
The tumor genetic subtypes were basal-like in 24 cases (25.8%), luminal A
Summary
Breast cancer has the second highest rate of brain metastases (BM) (30%) after lung cancer (34%) [1,2,3,4]. Whole brain radiation therapy (WBRT) has been a leading treatment option for years; due to the development of new treatment modalities such as radiosurgery, discussing the most effective method to treat a particular patient has become a major focus. The prognosis of patients with BM remains poor, with a median survival less than one year after the diagnosis of BM [5]. Predictive factors for BM with breast cancer have been identified, such as an overexpression of human epidermal growth factor receptor 2 (HER2), a lack of expression of hormone receptors, a patient age under 50 years, a triple negative subtype and the presence of lung metastases [6,7,8,9,10]. Prognostic indexes are used to predict survival periods of patients with BM to determine if a patient would benefit from therapy before treatment begins.
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