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

Rudat V, El-Sweilmeen H, Brune-Erber I, Nour AA, Almasri N, Altuwaijri S, Fadel E - BMC Cancer (2014)

Bottom Line: 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).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).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Saad Specialist Hospital, P,O, Box 30353, Al Khobar 31952, Saudi Arabia. vrudat@saadmedical.com.

ABSTRACT

Background: The 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.

Methods: Medical 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.

Results: On 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).

Conclusions: Breast 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.

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Brain metastases-free survival of breast cancer patients with triple negative versus luminal A, B and HER2 overexpressing.
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Figure 2: Brain metastases-free survival of breast cancer patients with triple negative versus luminal A, B and HER2 overexpressing.

Mentions: On univariate analysis, the ER status (Figure 1), the PR status, and the tumor subtype (Figure 2) had a statistically highly significant impact on the brain metastasis-free survival (Table 1). A closer look at the tumor subtype revealed that the triple negative receptor status had a significantly adverse impact on the brain metastasis-free survival (log rank test, p < 0.01) compared to the combined subtypes luminal A, luminal B and HER2 overexpressing. Young age at diagnosis (≤35 years) and disease stage showed no statistically significant impact (p = 0.10). On multivariate analysis, the only independent significant factor on the brain metastasis-free survival was the ER status (negative ER status, hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). Of 109 patients with a negative ER status 11 developed brain metastasis during the follow-up period and of 238 ER positive patients five.


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

Rudat V, El-Sweilmeen H, Brune-Erber I, Nour AA, Almasri N, Altuwaijri S, Fadel E - BMC Cancer (2014)

Brain metastases-free survival of breast cancer patients with triple negative versus luminal A, B and HER2 overexpressing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4006960&req=5

Figure 2: Brain metastases-free survival of breast cancer patients with triple negative versus luminal A, B and HER2 overexpressing.
Mentions: On univariate analysis, the ER status (Figure 1), the PR status, and the tumor subtype (Figure 2) had a statistically highly significant impact on the brain metastasis-free survival (Table 1). A closer look at the tumor subtype revealed that the triple negative receptor status had a significantly adverse impact on the brain metastasis-free survival (log rank test, p < 0.01) compared to the combined subtypes luminal A, luminal B and HER2 overexpressing. Young age at diagnosis (≤35 years) and disease stage showed no statistically significant impact (p = 0.10). On multivariate analysis, the only independent significant factor on the brain metastasis-free survival was the ER status (negative ER status, hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). Of 109 patients with a negative ER status 11 developed brain metastasis during the follow-up period and of 238 ER positive patients five.

Bottom Line: 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).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).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Saad Specialist Hospital, P,O, Box 30353, Al Khobar 31952, Saudi Arabia. vrudat@saadmedical.com.

ABSTRACT

Background: The 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.

Methods: Medical 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.

Results: On 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).

Conclusions: Breast 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.

Show MeSH
Related in: MedlinePlus