Hormone receptor status as a prognostic factor affecting the outcome of brain metastases

Abstract

Hormone receptor status as a prognostic factor affecting the outcome of brain metastases To The Editor, We congratulate Liu et al. [1] for their retrospective study in which they tried to determine prognostic factors affecting outcomes of brain metastases from breast cancer. They found that Karnofsky performance status and the number of brain metastases were statistically significant for overall survival in multivariate analysis. However, they did not include hormone receptor status in predicting survival rate. Recent retrospective study evaluated clinical data from 420 patients who had been diagnosed with breast cancer and brain metastasis between 1994 and 2004 at M. D. Anderson Cancer Center. In this study, median follow-up after brain metastasis was 6 months (range 0.7 to 95.9 months), and the overall median survival was 6.8 months [2]. In univariate analysis, younger patients, positive hormone receptor status, single metastatic lesion of brain, and brain metastases as a site of the first metastasis had significantly better survival. However, only the age at the time of diagnosis and estrogen receptor (ER) were significantly associated with overall survival in the multivariate analysis. Patients with ER-positive disease tended to have longer overall survival compared to patients with ER-negative disease (p=0.003). Patients 50 years of age or less tended to have longer overall survival compared to patients more than 50 years of age (p=0.047). HER2 was not included in this analysis because of the large amount of missing data associated with this characteristic. In conclusion, although the survival of patients with breast cancer metastatic to brain is generally poor, there are some long-term survivors such as younger patients with hormone receptor positive histology, good performance status, and single metastatic lesion. More aggressive treatment approach may be considered for these patients. Detailed molecular characterization of brain metastases from breast cancer might lead to more in-depth understanding of those biological abnormalities. References1. Liu MT, Hsieh CY, Wang AY, Chang TH, Pi CP, Huang CC, Huang CY, Liou CH (2006) Prognostic factors affecting the outcome of brain metastases from breast cancer. Support Care Cancer 14:936-942 2. Altundag K, Bondy ML, Kau SW, Broglio K, Rivera E (2005) Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastases. Breast Cancer Res Treat 94 (Suppl 1):S143(Abstract 3056)