Clinical Outcomes in Patients with Triple-negative Breast Cancer and Brain Metastases

Abstract

Purpose: Patients with triple-negative breast cancer (TNBC) are known to carry an increased risk of distant metastasis and poor survival. The principal objective of this study was to investigate survival after brain metastases in patients with TNBC. Methods: The authors retrospectively evaluated clinical data obtained from 66 patients who had been diagnosed with breast cancer and brain metastasis from 2003 to 2009. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor-2 (HER2) statuses were determined via immunohistochemical staining. TNBCs were defined as those that were ER-negative, PR-negative, and HER2-negative. The time interval from initial diagnosis to brain metastasis and overall survival after brain metastasis was evaluated via the Kaplan-Meier method. Results: Twenty four (40.0%) of 60 patients were diagnosed with TNBC. The clinicopathologic characteristics did not differ between the TNBC and non-TNBC patients. The disease-free survival durations of the TNBC and non-TNBC subjects were 17.9 and 25.6 months, respectively (p=0.135). The time intervals from initial diagnosis to brain metastasis were 25.5 and 43.7 months, respectively (p=0.027). The time intervals from distant metastasis to brain metastasis were 8.4 and 19.5 months, respectively (p=0.006). Overall survival durations from brain metastasis to death were 4.3 and 7.6 months, respectively (p=0.046). Conclusion: Patients with TNBC were more likely to develop brain metastasis earlier, and exhibit poor overall survival. Triple receptor status may be utilized as a prognostic marker for breast cancer patients with brain metastasis.

Prognostic factors for patients with newly diagnosed brain metastasis from breast cancer

“…We initially evaluated the influence of biology from initial breast tumor over BM behavior and similarly to other publications we found that more advanced CS, ER-negative status, nonluminal and TN phenotypes were associated to shorter both TTCNS and survival after BM [1,2,4- 10,13]. These factors could predispose cancer cells not only to invade but also to grow inside brain tissue.…”

Brain metastases originating in breast cancer: clinical-pathological analysis and immunohistochemical profile

“…Negative HR status, nuclear grade 3, four or more positive lymph nodes and higher stage of the disease were factors considered to be associated with short time to BM in their series [31]. Kwon et al (2010) found that the time period from the initial BC to the onset of BM was 52.9, 33.6, and 25.5 months for patients with HR+, HER2+, and triple receptor negative tumors [32], which can probably be extrapolated in our study, because there is a link between the presence of these molecular markers and the evolution of BC in our patients. The prognostic factors involved in the development of BM originating in BC are tumor phenotype (HER2, ER status, HP grade, proliferative rate), the degree of the extension of the disease outside the brain (the presence of lung, bone and/or BMs), patient's age, as well as patient performance status [33,34].…”