Luminal Subtypes Predict Improved Survival Following Central Nervous System Metastasis in Patients With Surgically Managed Metastatic Breast Carcinoma

Abstract

Context.-Metastatic breast cancer to the central nervous system (CNS) is second only to lung cancer metastasis to the CNS in frequency. Patients with triple-negative primary breast cancer and those with human epidermal growth factor receptor 2 (HER2)-positive primary breast cancer are at an increased risk for metastasis. Very little is known about predictive or prognostic variables once patients develop CNS metastases. Currently, therapeutic options are limited, with surgery generally offered primarily to those with solitary lesions.Objectives.-To determine the influence of molecular subtypes of metastatic breast cancer on survival from the time of CNS metastasis and to aid in the prognostic stratification of these patients.Design.-We identified 59 cases of metastatic breast cancer to the CNS and analyzed them for various demographic and clinicopathologic parameters. Tumors were categorized into molecular subtypes using immunohistochemical methods: luminal A [estrogen receptor, and triple-negative. Survival after CNS metastasis for each group was plotted using a KaplanMeier curve, and multivariate analysis was performed.Results.-Patients with metastases from luminal tumors had a statistically significant survival advantage when compared with those of the triple-negative phenotype. Importantly, survival among patients with luminal A and luminal B tumors was not significantly different. Similarly, patient's age, histologic grade, and number of lesions did not contribute to determining outcomes.Conclusions.-Estrogen receptor positivity (ie, luminal phenotype) of tumors appears to determine outcomes after development of metastases. In contrast, proliferation rate had little or no effect on the long-term survival. Understanding the biology of metastases can help stratify patients into prognostically meaningful categories and tailor treatment regimens for individual patients.

Brain Metastases in Newly Diagnosed Breast Cancer

“…Data from single institution experiences and prospective studies have yielded varying results. Triple-negative subtype seems to be associated with a poorer prognosis . Other sociodemographic and clinical predictors of outcome, on a population level, have not been well characterized.…”

Grading system for blood vessel tumor emboli of invasive ductal carcinoma of the breast

“…HER2 expression in tumor cells was categorized according to the definition of Wolff et al [14]. The MIB-1 labeling index of stroma-invasive tumor cells was calculated in 500 or more tumor cells in 1 high-power field (hot spot) within the invasive tumor area and was set at a threshold of 14% [15]. The MIB-1 labeling index of blood vessel tumor emboli was calculated for positive tumor cells among all the tumor cells forming the blood vessel tumor emboli.…”

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

“…We determined a higher cutoff age value (50 years), which remained significant in the multivariate analysis model. Patients with the TN subtype are reported to have the shortest interval between BC and CNSm and are considered to have the worst prognosis 21 ; in the current study, patients with CNSm arising from the TN subtype had the worst MOS. Surprisingly, we observed that patients with the LumA subtype had a shorter MOS compared with those reported in other studies, which might be due to the high frequency of NM in the current study.…”