Identification of breast cancer patients with a high risk of developing brain metastases: a single-institutional retrospective analysis

Abstract

BackgroundThe objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention.MethodsMedical records of 352 breast cancer patients with local or locoregional disease at diagnosis were retrospectively analysed. The brain metastasis-free survival was estimated using the Kaplan-Meier method and patient groups were compared using the log rank test. The simultaneous relationship of multiple prognostic factors was assessed using Cox’s proportional hazard regression analysis. The Fisher exact test was used to test the difference of proportions for statistical significance.ResultsOn univariate analysis, statistically highly significant unfavourable risk factors for the brain metastasis-free survival were negative ER status, negative PR status, and triple negative tumor subtype. Young age at diagnosis (≤35 years) and advanced disease stage were not statistically significant (p = 0.10). On multivariate analysis, the only independent significant factor was the ER status (negative ER status; hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). In the subgroup of 168 patients with a minimum follow-up of 24 months, 49 patients developed extracranial metastases as first metastatic event. Of those, 7 of 15 (46.6%) with a negative ER status developed brain metastases compared to 5 of 34 (14.7%) with a positive ER status (Fisher exact test, p = 0.03). The median time interval (minimum-maximum) between the diagnosis of extracranial and brain metastases was 7.5 months (1-30 months).ConclusionsBreast cancer patients with extracranial metastasis and negative ER status exhibited an almost 50% risk of developing brain metastasis during their course of disease. Future studies are highly desired to evaluate the efficacy of pre-emptive medical intervention such as prophylactic treatment or diagnostic screening for high risk breast cancer patients.

First report on molecular breast cancer subtypes and their clinico-pathological characteristics in Eastern Morocco: series of 2260 cases

“…Such a finding is similar to those observed in other North African countries, Saudi Arabia, China and the United States [13, 28, 41, 60–65]. Regarding the PR status, we found that the majority of tumors were PR+ (66.5%).…”

“…This result is similar to those reported in other North African countries, Saudi Arabia, but higher than the figure reported in Europe, the United States and most countries in Sub-Saharan Africa [13, 18, 28, 30, 60, 62, 63, 65, 72, 73]. Women whose breast cancers test positive for HER2 can be given targeted therapy.…”

“…Regarding the PR status, we found that the majority of tumors were PR+ (66.5%). This result is similar to those reported in Fez, Saudi Arabia, but higher than the figure reported in other North African countries [13, 28, 41, 60–65]. Hormone Receptor (HR) status has important implications for breast cancer prognosis and management.…”

Impact of breast cancer subtypes and patterns of metastasis on outcome

“…Definition of the intrinsic subtypes was made according to the recommendation of the St. Gallen conference 2011 with immunohistochemical status and proliferation activity [9]. Determination of Ki67 was not a standard procedure in breast cancer within the analyzed period.…”

“…Prognosis of metastatic disease depends on hormonal receptor status, with a better prognosis for hormone receptor positive disease [5][6][7][8]. It also depends on the first site of metastases, with the best outcome for bone metastasis and the worst for brain metastases [5][6][7][8][9]. Hormone receptor positive disease preferentially metastasizes into bone as first site, whereas hormone receptor negative disease presents with multiple sites of visceral metastases [10].…”