Analysis of Prognostic Factors Affecting the Brain Metastases Free Survival and Survival After Brain Metastases in Breast Cancer.

Weikai Xiao,Anli Yang,Bo Chen,Wenju Deng,Guochun Zhang,Xuerui Li,Shaoquan Zheng,Ning Liao

doi:10.3389/fonc.2020.00431

Abstract

This study aimed to analyze the factors affecting brain metastases free survival (BMFS) and the survival after brain metastases (SABM). The data of 215 patients with breast cancer brain metastases (BCBM) in Sun Yat-sen University Cancer Center from January 2000 to August 2017 were retrospectively analyzed. The clinicopathological features of BCBM were analyzed, and their effects on BMFS and SABM were analyzed by univariate and multivariate COX regression. Finally, it was analyzed whether the receptor status of the brain metastases and the primary lesions were consistent. The median age of the entire cohort was 46 years old. The median BMFS, SABM and overall survival were 31, 9 and 44.2 months, respectively. Clinical stage, molecular subtypes and bone metastasis were independent prognostic factors affecting BMFS. TNM stage IV (HR, 4.99 [95% CI, 2.13–11.7]) and triple negative subtype (HR, 2.06 [95% CI, 1.35–3.14]) was significantly associated with shorter BMFS, but the presence of bone metastases (HR, 0.63 [95% CI, 0.45–0.88]) was a favorable factor for BMFS. Molecular subtypes, resection of BCBM and whole brain radiotherapy (WBRT) were independent factors for SABM. The triple negative subtype (HR, 2.02[95% CI, 1.12–3.64]) was significantly associated with shorter SABM. However, resection of BCBM (HR, 0.31 [95% CI, 0.15–0.65]) and WBRT (HR, 0.57 [95% CI, 0.35–0.93]) were independent factors in improving SABM. The conversion rate of ER was 11.1%, PR was 29.6%, and HER2 was 3.7% between paired breast cancer and brain metastases. BMFS and SABM have different influencing factors. Resection of BCBM and WBRT can significantly improve SABM. The frequency of HER2 status changes between the paired BCBM and the primary lesions is low.

Highlights

Despite significant advances in the diagnosis and treatment of breast cancer, metastasis is still an important factor that seriously affects patients’ quality of life and prognosis
The incidence of breast cancer brain metastases (BCBM) has been increasing in recent years and has become a major limitation on the survival and quality of life for many breast cancer patients
This study found that molecular subtypes significantly affect the occurrence and prognosis of brain metastases

Summary

Introduction

Despite significant advances in the diagnosis and treatment of breast cancer, metastasis is still an important factor that seriously affects patients’ quality of life and prognosis. It has been reported that distant metastases have been found at the initial diagnosis of breast cancer in about 6–10% of patients [1]. 30 to 40% of patients with early-stage breast cancer will have recurrence and metastasis during the postoperative follow-up period and progress to advanced breast. The bones, lungs, liver and brain are the four most common distant metastatic sites of breast cancer [3]. It is worth noting that the incidence of brain metastases seems to be increasing in recent years. The progress of brain imaging technology has increased the detection rate of brain metastases. The incidence of brain metastases from breast cancer ranks second, accounting for about 10 to 16%, second only to that of lung cancer [5, 6]

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