Risk factors for breast cancer brain metastases: a systematic review

Abstract

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)

Breast cancer patients treated with intrathecal therapy for leptomeningeal metastases in a large real-life database

“…19 BC subtypes also have different propensities to metastasize to the leptomeninges compared with brain parenchyma. We observed a higher prevalence of LM in TN BC, but not in HER2þ tumours (despite the higher prevalence of brain metastases 20 ), in line with previous reports. 10,21 Interestingly, w20% of our selected patients had LM at the time of metastatic relapse, while the majority of patients had been heavily pretreated and had extensive systemic disease at LM diagnosis, confirming previous data.…”

Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis

“…Despite the overall limitations in terms of available data, some information could be gathered from breast cancer, since this topic has been extensively investigated in this tumor type. A recent meta-analysis [52] suggested that ER negativity was an independent risk factor for BMs development, and that the triple-negative (ER, PgR and HER-2 negative) breast cancers showed shorter time to BMs development from the diagnosis of the primary tumor, compared to other breast cancer subtypes. Few data are available concerning AR expression, but overall it appears that this receptor is not related to the risk of developing distant metastases in triple-negative breast cancer [53].…”

Breast Cancer Brain Metastasis—Overview of Disease State, Treatment Options and Future Perspectives

“…Some studies have reported various risk factors including cancer subtype associated with the incidence of BCBM. Recently, Koniali et al performed a systematic review to identify the risk factors of BCBM [ 12 ]. They found that younger age, estrogen receptor (ER)-negative status, HER2-positive status, higher tumor stage, higher histologic grade (HG), large tumor size, and high Ki67 labeling index were independent risk factors for BCBM.…”