Risk factors for breast cancer brain metastases: a systematic review.

Lola Koniali,Constantinos Pitris,Andreas Hadjisavvas,Kyproula Christodoulou,Constantinos S Pattichis,Anastasia Constantinidou,Yiolanda Christou,Kyriacos Kyriacou,Christiana Demetriou,Andreas S Panayides,Eleni Zamba-Papanicolaou

doi:10.18632/oncotarget.27453

Lola Koniali, Constantinos Pitris + Show 9 more

Open Access

https://doi.org/10.18632/oncotarget.27453

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Abstract

Background: Brain metastasis (BM) is an increasingly common and devastating complication of breast cancer (BC).Methods: A systematic literature search of EMBASE and MEDLINE was conducted to elucidate the current state of knowledge on known and novel prognostic factors associated with 1) the risk for BCBM and 2) the time to brain metastases (TTBM).Results: A total of 96 studies involving institutional records from 28 countries were identified. Of these, 69 studies reported risk factors of BCBM, 46 factors associated with the TTBM and twenty studies examined variables for both outcomes. Young age, estrogen receptor negativity (ER-), overexpression of human epidermal factor (HER2+), and higher presenting stage, histological grade, tumor size, Ki67 labeling index and nodal involvement were consistently found to be independent risk factors of BCBM. Of these, triple-negative BC (TNBC) subtype, ER-, higher presenting histological grade, tumor size, and nodal involvement were also reported to associate with shorter TTBM. In contrast, young age, hormone receptor negative (HR-) status, higher presenting stage, nodal involvement and development of liver metastasis were the most important risk factors for BM in HER2-positive patients.Conclusions: The study provides a comprehensive and individual evaluation of the risk factors that could support the design of screening tools and interventional trials for early detection of BCBM.

Highlights

Breast cancer (BC) is the most frequently diagnosed cancer among women worldwide, accounting for over 1.67 million new cases annually [1]
Brain metastasis (BM) is considered a late event in the progression of breast cancer (BC), occurring 2 to 3 years after initial diagnosis, and it is typically preceded by lung, liver and/or bone metastases [5, 6]
After exclusion of duplicates and screening of titles and abstracts, a shortlist of 184 manuscripts were reviewed in full-text, and 96 of these were included in the review

Summary

Introduction

Breast cancer (BC) is the most frequently diagnosed cancer among women worldwide, accounting for over 1.67 million new cases annually [1]. It is the second leading cause of brain metastases (BM), with the reported prevalence among BC patients ranging from 10–16% and reaching 20–36% when data from autopsy series are included [2, 3]. Cases of direct BC to BM are not uncommon (~12% of BCBM cases), as the unique anatomy of the human brain is thought to be providing a sanctuary site for tumor cells [7]. Brain metastasis (BM) is an increasingly common and devastating complication of breast cancer (BC)

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