Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer

Bing Sun,Zhou Huang,Santai Song,Shikai Wu,Ge Shen,Lei Cha,Junliang Wang,Lijuan Ding

doi:10.18632/oncotarget.12176

Abstract

PurposeBrain metastasis (BM) with a cystic component from breast cancer is rare and largely uncharacterized. The purpose of this study was to identify the characteristics of cystic BM in a large cohort of breast cancer patients.ResultsA total of 35 eligible patients with cystic BM and 255 patients with solid BM were analyzed. Three factors were significantly associated with an increased probability of developing cystic lesions: age at diagnosis ≤ 40 years, age at BM ≤ 45 years, and poor histological grade (p < 0.05). Patients with cystic metastasis were also characterized by a larger metastasis volume, a shorter progression-free survival (PFS) following their first treatment for BM, and poor overall survival after BM (p < 0.05). Multivariate analysis further demonstrated that local control of cystic BM was only potentially achieved for HER2-negative primary tumors (p = 0.084).MethodsBreast cancer patients with parenchymal BM were reviewed from consecutive cases treated at our institution. Cystic BM was defined when the volume of a cystic lesion was greater than 50% of the aggregated volume of all lesions present. Clinicopathologic and radiographic variables were correlated with development of cystic lesions and with prognosis of cystic BM.ConclusionsThis study shows that cystic BM from breast cancer, a special morphological type of BM, had worse prognosis than the more commonly observed solid BM. Younger age and low tumor grade were associated with the development of cystic lesions. Further comprehensive research and management of cystic BM are warranted to improve its poor prognosis.

Highlights

Brain metastasis (BM) is a common intracranial tumor and one of the principle causes of death in cancer patients
The risk factors related to the probability of developing cystic metastasis were analyzed (Table 1) and an age at diagnosis ≤ 40 years, an age at BM ≤ 45 years, and poor histological grade were significantly associated with the development of cystic lesions (p < 0.05 in each case)
Patients with cystic tumors were younger in age and their tumors were more aggressive compared with the patients with solid BM

Summary

Introduction

Brain metastasis (BM) is a common intracranial tumor and one of the principle causes of death in cancer patients. It is currently known that BM predominantly originates from lung cancer, breast cancer, and other malignancies, and the prognosis of patients with BM from breast cancer has been extensively characterized [1,2,3]. The survival time of patients with breast cancer BM has been found to be the longest. The incidence of BM has been escalating due to an increase in patient cancer survival and advances in brain screening technologies. It is estimated that approximately 10–30% of patients with breast cancer will develop BM [4]. Many studies have focused on the treatment and outcome for patients with breast cancer BM [5,6,7]

Objectives

Results

Conclusion