Survival in patients with brain metastasis secondary to breast cancer from Saudi Arabia.

Abstract

e14018 Background: Breast cancer (BC) is the most common malignancy in women from Saudi Arabia. Nearly one-third of the patients present with metastatic disease. Data on the incidence, pattern and outcome of brain metastasis (BM) in breast cancer patients is yet to be reported to inform the practice and help in assessing the current standard of care. Methods: A retrospective cohort study between the years 2015 and 2020 that included BC patients with BM was conducted. Demographic data, tumor clinico-pathological features, treatment modalities and outcomes were obtained. Survival, factors influencing survival time and the risk of death were examined. A p-value of less than 0.05 was considered statistically significant. Results: 111 patients with BM due to BC were included in the analysis. All are female with a mean age 50.28 ± 11.61 years. IDC histology (93%), grade III (71%), tumor > T2 (64%) and N-positive (60%) BC accounted for the majority. Human epidermal growth factor receptor2 (HER2)-positive/Hormone receptors (HR)-negative was 21%, HER2-positive/HR-positive was 16%, HR-positive/HER2-negative was 31%, TNBC was 22.5% and unknown subtype in 10%. 60% had metastatic disease on presentation with 41% had both skeletal and visceral metastases. Brain lesions > three were reported in nearly half of the cohort. Whole brain radiotherapy (WBRT), surgical resection and SRS were reported in 84%, 16% and 22%, respectively. The mean survival time was 3.31 years with a maximum of 4.23 years and a minimum of 2.39 years. Patients with HR-positive and HER2-positive BC had a significant longer survival (p=0.039, 0.033 respectively). Neither tumor size nor nodal status in BC patients with BM influenced survival time. The presence of visceral metastasesincreased the likelihood of death in BC patients with BM up to 6 folds (p=0.031). The relationship between risk of death, treatment modalities, and response of BM is shown. Conclusions: Although BM secondary to BC represents a therapeutic challenge with an expected unfavorable impact on survival, mortality was associated with the presence of extra-cranial metastases, particularly visceral metastases in this cohort. Longer survival was seen with specific subtypes (HR-positive and HER2-positive), suggesting advancement in systemic treatments against them. [Table: see text]