OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.
PURPOSE This study aims to conduct a systematic review of the literature to identify biomarkers associated with breast cancer brain metastasis (BCBM). METHODS A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane for relevant literature up until October 1, 2018. Case reports, conference abstracts, and expert opinions/letters were excluded. Studies were included if they investigated risk factors for BCBM in a cohort of patients with locoregional or metastatic breast cancer of any subtype. RESULTS From the 4866 studies that were screened, 117 were selected for inclusion and review. Twenty-eight unique biomarkers were investigated, of which three (EGFR, Ki-67, and p53) were assessed by more than two authors. In a pooled analysis of 3 studies, EGFR expression was associated with an increased risk of BM (RR 3.48, 95% CI 2.27–5.32, I2=0%, p-interaction = 0.39, n= 571 patients). In a pooled analysis of 5 studies, increased Ki-67 expression was associated with an increased risk of BM (RR 2.91, 95% CI 1.96–4.32, I2=59%, p-interaction = 0.05, n= 1,178). In a pooled analysis of 4 studies, p53 expression was not associated with a statistically significant risk of BM (RR 1.42, 95% CI 0.98–2.06, I2=53%, p-interaction = 0.10, n= 738). CONCLUSION This study summarizes the various biomarkers investigated for a role in breast cancer brain metastasis. Two biomarkers, EGFR and Ki-67 were identified as having a statistically significant increased risk of BCBM while p53 was not found to be statistically significant. Future studies are needed to develop more robust prediction models, as well as evaluate the other biomarkers identified in this study, which could help clinicians identify patients at high risk of breast cancer brain metastasis.
BACKGROUND Local recurrence is a common occurrence after resection or radiotherapy for brain metastasis (BM). Very little is known about the benefit of (re-)craniotomy in this scenario: does resecting the initial local recurrence (LR1) invariably lead to a second local recurrence (LR2)? This study aimed to analyze occurrence and predictors of LR2 in BM patients undergoing craniotomy for LR1. METHODS Patients were identified from a departmental database at the Brigham and Women’s Hospital, Boston, MA. Multivariable logistic regression and cox regression analysis was performed to identify predictors of binary occurrence of LR2 (yes/no) and time-to-LR2, respectively. Based on predictors, subgroup-specific prevalence of LR2 was explored. RESULTS A total of 188 patients were identified. The median age was 59.5 years and 117 patients (62.2%) were female. Treatment-wise, 64 patients (34.0%) underwent subtotal resection (STR) and 66 (35.1%) received adjuvant radiation. Eighty-one (43.1%) patients experienced LR2 at a median of 7 months after craniotomy. Occurrence of LR2 was significantly associated with STR (OR 6.88, p = 0.0008), surgery as treatment for LR1 (OR = 0.26, p = 0.03), larger tumor volume (OR = 1.14 per 1000 mm3, p = 0.01), and frontal location (OR = 5.23, p = 0.02). Shorter time-to-LR2 was associated with STR (HR = 5.31, p = 0.01) and adjuvant radiation (HR = 2.22, p = 0.03), while temporal (HR = 0.16, p = 0.03) and parietal (0.13, p = 0.03) location were associated with longer time-to-LR2. When stratifying by extent of resection, prevalence of LR2 was 32.8% after gross total resection and 57.1% after STR. CONCLUSION In this population, LR2 occurred in 43.1% of patients. STR was the strongest risk factor for LR2, while tumor size, location, surgical treatment of LR1, and receipt of adjuvant radiation may also influence subsequent recurrence.
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