Clinicopathological factors associated with survival in patients with breast cancer brain metastasis

Li, Rong; Zhang, Kui; Siegal, Gene P.; Wei, Shi

doi:10.1016/j.humpath.2017.03.022

Cited by 15 publications

(20 citation statements)

References 24 publications

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“…Similar results were observed across seven studies [24,30,70,84,91,97,98] stratifying patients into three BC subtypes (HR+/HER2-, HR±/HER2+, and HR-/HER2-), with the TNBC tumors demonstrating the shortest TTBM (20-25.5 months from primary diagnosis and 9-14 months from MBC) and HR+/HER2-the longest (42-63.5 months from primary diagnosis and 20.6-34 months from MBC). Interestingly, in two studies stratifying BCBM patients into HR+, HR-/ HER2+ and HR-/HER2-, no significant difference in the median time interval between BC and BM diagnosis [94], or first BM treatment [89] were observed, across BC subtypes. Similarly, of the seven studies that compared TTBM between TNBC and non-TNBC cases [10,12,87,95,99,105], 4 reported no significant difference between the two groups [10,46,87,95].…”

Section: Er Pr and Her2 Statuses And Ihc Bc Subtypesmentioning

confidence: 98%

“…Not surprisingly, advanced stage disease (Stage ≥ III or stage IV) at primary BC diagnosis was predictive of shorter TTBM [11,90,92,94,96,106]; with four studies [11,94,104], including one involving solely TNBC cases [39] reporting a statistically significant multivariable associations: Stage III/IV, HR: NR, p = 0.033/ 0.047; HR: 3.389/6.643, p = 0.016/0.025; HR: 3.96, p < 0.001; HR: 3.51, p = 0.001, respectively. The exceptions were three studies, one involving early stage/non metastatic patients [30], one measuring TTBM from time of first distant metastasis [84], and the other comparing localized to regional stage disease [58].…”

Section: T N and M Statuses And Clinical Stagementioning

confidence: 98%

“…The majority of the eligible studies were limited to reporting univariate association between BC subtypes or a single candidate factor with TTBM. Only fourteen studies provided multivariable TTBM estimates for variables [11,28,39,58,63,70,76,83,84,90,94,96,102,104].…”

Section: Group B -Prognostic Factors Associated With the Ttbmmentioning

confidence: 99%

“…With the exception of a single study reporting shorter TTBM as first site of relapse in patients >35years and stage III at primary diagnosis [96], age was considered but not found to significantly associate with early onset of BCBM progression [11,28,39,58,70,78,83,84,90,94,96,106]. Additionally, controversial results were reported across four studies accessing the effect of menopausal status on the TTBM [15,58,90,106].…”

Section: Age and Menopausal Statusmentioning

confidence: 99%

“…The impact of IHC-defined BC subtypes on TTBM was examined via multivariable analysis in only five studies [58,70,84,90,94], of which three [70,84,90] reported significant multivariable associations (HR:2.0, p = 0.004 for HR-/HER2+, HR:1.51, p = 0.0002 for nonluminal BC subtypes, and sHR: 2.08, p = 0.03 for HR-/ HER2-, respectively). Univariate analysis in the rest of the studies revealed significant differences in TTBM among BC subtypes; though variability in the classification of BC subtypes and in the cut-off points used for calling ER/PR positivity was observed.…”

Section: Er Pr and Her2 Statuses And Ihc Bc Subtypesmentioning

confidence: 99%

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Risk factors for breast cancer brain metastases: a systematic review

et al. 2020

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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. Lymph node status (N-Stage)

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Section: Er Pr and Her2 Statuses And Ihc Bc Subtypesmentioning

confidence: 98%

Section: T N and M Statuses And Clinical Stagementioning

confidence: 98%

Section: Group B -Prognostic Factors Associated With the Ttbmmentioning

confidence: 99%

Section: Age and Menopausal Statusmentioning

confidence: 99%

Section: Er Pr and Her2 Statuses And Ihc Bc Subtypesmentioning

confidence: 99%

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Risk factors for breast cancer brain metastases: a systematic review

et al. 2020

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Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms

Cacho-Díaz

Salmerón-Moreno

Alvarez-Alvarez

et al. 2020

Cancer

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Background The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm). Methods The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro‐oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis. Results Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15‐76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8‐3.5 [P < .0001]), human epidermal growth factor receptor 2 (HER2)–positive status (HER2+) (OR, 3.6; 95% CI, 2.1‐6.1 [P < .0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9‐5.3 [P < .001]), triple‐negative subtype(OR, 2.4; 95% CI, 1.5‐4 [P = .001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5‐9.6 [P < .0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3‐15.1 months). Conclusions CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro‐oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple‐negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non‐CNS metastases.

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Clinico–pathologic factors and survival of patients with breast cancer diagnosed with de novo brain metastasis: a national cancer database analysis

Hijazi,

Mohanna,

Sabbagh

et al. 2024

Breast Cancer Res Treat

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Purpose Patients with Breast Cancer (BC) with Brain Metastasis (BCBM) have poor survival outcomes. We aimed to explore the clinico–pathologic and therapeutic factors predicting the survival in patients with de novo BCBM using the National Cancer Database (NCDB). Patients and methods The NCDB was queried for patients with BC between 2010 and 2020. Survival analysis with Kaplan–Meier curves and log rank tests were used to find median overall survival (OS) in months (95% CI) across the different variables. A multivariate cox regression model was computed to identify significant predictors of survival. Results Out of n = 2,610,598 patients, n = 9005 (0.34%) had de novo BCBM. A trend of decreasing OS was observed with increasing age, Charlson–Deyo score (CDS), and number of extracranial metastatic sites. The highest median OS was observed in the Triple Positive and the lowest OS in the Triple Negative subgroup. Based on treatment regimen, combination of systemic therapy and local therapy achieved the highest OS. A positive trend in OS was observed in the BC subgroup analysis with targeted therapy demonstrating a survival benefit when added to systemic therapy. The multivariate cox regression model showed that age, race, ethnicity, insurance, median income, facility type, CDS, BC subtype, metastatic location sites, and treatment combinations received were significantly associated with risk of death. Receiving only local treatment for BM without systemic therapy more than doubled the risk of death compared to combining it with systemic therapy. Conclusions This analysis suggests that treatment of systemic disease is the major factor influencing survival in patients with BCBM. Moreover, targeted therapy with anti–HER2 increased survival when added to systemic therapy explaining the highest median OS noted in the Triple Positive subgroup.

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Clinicopathological factors associated with survival in patients with breast cancer brain metastasis

Cited by 15 publications

References 24 publications

Risk factors for breast cancer brain metastases: a systematic review

Risk factors for breast cancer brain metastases: a systematic review

Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms

Clinico–pathologic factors and survival of patients with breast cancer diagnosed with de novo brain metastasis: a national cancer database analysis

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