Breast Cancer Subtypes and Mortality of Breast Cancer Patients With Brain Metastasis at Diagnosis: A Population-Based Study

Abstract

Background Brain metastasis is an important cause of breast cancer-related death. Aim We evaluated the relationships between breast cancer subtype and prognosis among patients with brain metastasis at the initial diagnosis. Methods The Surveillance, Epidemiology, and End Results database was searched to identify patients with brain metastasis from breast cancer between 2010 and 2015. Multivariable Cox proportional hazard models were used to identify factors that were associated with survival among patients with initial brain metastases. The Kaplan–Meier method was used to compare survival outcomes according to breast cancer subtype. Results Among 752 breast cancer patients with brain metastasis at diagnosis, 140 patients (18.6%) underwent primary surgery and 612 patients (81.4%) did not undergo surgery, while 460 patients (61.2%) received chemotherapy and 292 patients (38.8%) did not receive chemotherapy. Multivariable analysis revealed that, relative to HR+/HER2– breast cancer, HR–/HER2– breast cancer was associated with significantly poorer overall survival (hazard ratio: 2.52, 95% confidence interval: 1.99–3.21), independent of age, sex, race, marital status, insurance status, grade, liver involvement, lung involvement, primary surgery, radiotherapy, and chemotherapy. The median overall survival intervals were 12 months for HR+/HER2−, 19 months for HR+/HER2+, 11 months for HR−/HER2+, and 6 months for HR–/HER2– ( P < .0001). Relative to HR+/HER2– breast cancer, HR–/HER2– breast cancer was associated with a significantly higher risk of mortality among patients, and the association was stronger among patients who received chemotherapy ( p for interaction = .005). Conclusions Breast cancer subtype significantly predicted overall survival among patients with brain metastasis at diagnosis.

Survival Analysis of Male Patients with Brain Metastases at Initial Breast Cancer Diagnosis over the Last Decade

“…Among male patients who presented with brain metastases at initial breast cancer diagnosis, poor OS was associated with advanced age, triple negative subtype, no primary surgery, no chemotherapy, and additional visceral metastases. These results are consistent with recent reports from SEER [ 24 , 31 ] and highlight the relevance of patient characteristics, tumor factors, and sociodemographic factors in the prognosis of patients with breast cancer brain metastases.…”

Innovative Approaches for Breast Cancer Metastasis to the Brain

“…Medical management of breast cancer brain metastasis (BCBM) is a challenging task and further compounded by the genetic heterogeneity of breast cancer (BC), which limits viable treatment options. The probability of developing a brain metastasis (BM) varies with the BC's molecular expression pattern [27]. which is not always identical to cells of the metastatic tumor [27][28][29].…”

“…The probability of developing a brain metastasis (BM) varies with the BC's molecular expression pattern [27]. which is not always identical to cells of the metastatic tumor [27][28][29]. It is well established that patients with human epidermal growth factor receptor-2 positive (HER2+) and triple negative (TNBC) breast cancers are more likely to develop BCBMs compared to other subtypes [30].…”

Clinical and pathological factors and outcome of central nervous system metastasis in breast cancer

“…Treatment of BMBC in older patients is challenging; therefore, it is likely that this group of patients has worse prognosis. Although most patients with BMBC are diagnosed at around 48–55 years of age ( 12 , 23 – 26 ), no differences have been reported between the molecular subtypes with respect to age at the diagnosis of BMBC ( 26 , 27 ). There have been conflicting reports regarding age as a possible independent prognostic risk factor in patients with BMBC.…”