Abstract
BackgroundThe objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention.MethodsMedical records of 352 breast cancer patients with local or locoregional disease at diagnosis were retrospectively analysed. The brain metastasis-free survival was estimated using the Kaplan-Meier method and patient groups were compared using the log rank test. The simultaneous relationship of multiple prognostic factors was assessed using Cox’s proportional hazard regression analysis. The Fisher exact test was used to test the difference of proportions for statistical significance.ResultsOn univariate analysis, statistically highly significant unfavourable risk factors for the brain metastasis-free survival were negative ER status, negative PR status, and triple negative tumor subtype. Young age at diagnosis (≤35 years) and advanced disease stage were not statistically significant (p = 0.10). On multivariate analysis, the only independent significant factor was the ER status (negative ER status; hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). In the subgroup of 168 patients with a minimum follow-up of 24 months, 49 patients developed extracranial metastases as first metastatic event. Of those, 7 of 15 (46.6%) with a negative ER status developed brain metastases compared to 5 of 34 (14.7%) with a positive ER status (Fisher exact test, p = 0.03). The median time interval (minimum-maximum) between the diagnosis of extracranial and brain metastases was 7.5 months (1-30 months).ConclusionsBreast cancer patients with extracranial metastasis and negative ER status exhibited an almost 50% risk of developing brain metastasis during their course of disease. Future studies are highly desired to evaluate the efficacy of pre-emptive medical intervention such as prophylactic treatment or diagnostic screening for high risk breast cancer patients.
Highlights
The objective of this study was to identify a subgroup of breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention
Breast cancer was classified according to the International Union Against Cancer (UICC), with group clinical and pathological staging according to the American Joint Committee on Cancer (AJCC, 6th edition)
The treatment of the patients consisted of mastectomy in 203 patients (57.7%), breast conserving surgery in 139 patients (39.5%), and nonsurgical treatment in 10 patients (2.8%)
Summary
The objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention. The identification of breast cancer patients with a high risk of developing brain metastases would enable preemptive intervention such as prophylactic treatment or diagnostic screening with the potential to improve the outcome. Reported risk factors for brain metastases in breast cancer patients include young age at first diagnosis, presence of lung metastases, short disease-free survival, ER negative tumors, triple-negative tumor subtype, HER2 overexpression and BRCA1 phenotype [1,5,14,15,16,17,18,19]. The objective of this study was to identify a subgroup of breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention
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