Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16–12)

Abstract

Purpose This study evaluated the influence of prognostic factors and whole brain radiotherapy (WBRT) on overall survival (OS) of breast cancer (BC) patients with brain metastases (BM). Methods and materials Medical records of 730 BC patients diagnosed with BM from 2000 to 2014 at 17 institutions were retrospectively reviewed. OS was calculated from BM diagnosis. Median follow-up duration was 11.9 months (range, 0.1–126.2). Results Median OS was 15.0 months (95% CI: 14.0–16.9). Patients with different BC-specific graded prognostic assessment (GPA) scores showed significant differences (p < 0.001) in OS. In multivariate analysis, histologic grade 3 (p = 0.014), presence of extracranial metastasis (p < 0.001), the number of BM (>4; p = 0.002), hormone receptor negativity (p = 0.005), HER2-negativity (p = 0.003), and shorter time interval (<30 months) between BC and BM diagnosis (p = 0.007) were associated with inferior OS. By summing the β-coefficients of variables that were prognostic in multivariate analyses, we developed a prognostic model that stratified patients into low-risk (≤0.673) and high-risk (>0.673) subgroups; the high-risk subgroup had poorer median OS (10.1 months, 95% CI: 7.9–11.9 vs. 21.9 months, 95% CI: 19.5–27.1, p < 0.001). Univariate and multivariate analyses of propensity score-matched patients diagnosed with BM ≥ 30 months after BC diagnosis (n = 389, “late BM”) revealed that WBRT-treated patients showed superior OS compared to non-WBRT-treated patients (p = 0.070 and 0.030, respectively). Conclusion Our prognostic model identified high-risk BC patients with BM who might benefit from increased surveillance; if validated, our model could guide treatment selection for such patients. Patients with late BM might benefit from WBRT as initial local treatment.

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

“…The impact of other univariate individual factors such as age, performance status, surgery, extracranial disease and number of lesions on OS in our study is in agreement with the results of other relevant studies. [9][10][11]23,30,31,36,37 Furthermore, our results of the multivariate regression analysis indicating an inferior OS in patients with ECOG !1 and no brain metastasis surgery as shown by the HR in Table 2 correspond with the results of earlier studies. 9,10,24,37 There are several limitations to this retrospective study.…”

“…WBRT is reported as the most common RT technique in treatment of brain metastases in breast cancer patients in the studies carried out by Znidaric et al, 9 Pasquier et al 24 and Kim et al, 30 covering patients treated between 2000 and 2015. The results of the current study (Table 2) agree with these findings.…”

SOX2 Promotes Brain Metastasis of Breast Cancer by Upregulating the Expression of FSCN1 and HBEGF

“…The median survival time of patients with BCBM is only 7.5-15 months. 3,4 Thus, BCBM is a serious threat to the life and health of patients.…”

Prognostic Factors and Survival Outcomes among Patients with Breast Cancer and Brain Metastases at Diagnosis: A National Cancer Database Analysis

“…Patients with brain metastases have been excluded from large phase III studies assessing the use of CDK4/6 inhibitors on patients with advanced, hormone-positive breast cancer. Even with the intervention of neurosurgery and radiotherapy, less than half of patients will live longer than 1 year after diagnosis with brain metastases [13, 14]. Characteristics that have been identified as being associated with worse survival in these patients are triple-negative tumor subtype, higher number of brain lesions, presence of extracranial metastases, presence of leptomeningeal disease, and ECOG performance status of 2 or higher [15, 16].…”