José Pablo Leone1, Julieta Leone2, Ariel Osvaldo Zwenger3, Julián Iturbe2, Bernardo Amadeo Leone2, Carlos Teodoro Vallejo2. 1. University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA. Electronic address: jose-leone@uiowa.edu. 2. Grupo Oncológico Cooperativo del Sur (GOCS), Argentina. 3. Grupo Oncológico Cooperativo del Sur (GOCS), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
Abstract
BACKGROUND: The presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD. METHODS: We evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS). RESULTS: We included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)+/HER2-, 17% HR+/HER2+, 14.1% HR-/HER2+ and 22.3% triple-negative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS. CONCLUSIONS: Although the prognosis of patients with BMIBCD is generally poor, 20.7% were still alive 3 years after the diagnosis. There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases.
BACKGROUND: The presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD. METHODS: We evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS). RESULTS: We included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)+/HER2-, 17% HR+/HER2+, 14.1% HR-/HER2+ and 22.3% triple-negative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS. CONCLUSIONS: Although the prognosis of patients with BMIBCD is generally poor, 20.7% were still alive 3 years after the diagnosis. There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases.
Authors: Paul W Sperduto; Shane Mesko; Jing Li; Daniel Cagney; Ayal Aizer; Nancy U Lin; Eric Nesbit; Tim J Kruser; Jason Chan; Steve Braunstein; Jessica Lee; John P Kirkpatrick; Will Breen; Paul D Brown; Diana Shi; Helen A Shih; Hany Soliman; Arjun Sahgal; Ryan Shanley; William Sperduto; Emil Lou; Ashlyn Everett; Drexell Hunter Boggs; Laura Masucci; David Roberge; Jill Remick; Kristin Plichta; John M Buatti; Supriya Jain; Laurie E Gaspar; Cheng-Chia Wu; Tony J C Wang; John Bryant; Michael Chuong; James Yu; Veronica Chiang; Toshimichi Nakano; Hidefumi Aoyama; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2020-02-19 Impact factor: 7.038
Authors: Amanda E D Van Swearingen; Marni B Siegel; Allison M Deal; Maria J Sambade; Alan Hoyle; D Neil Hayes; Heejoon Jo; Paul Little; Elizabeth Claire Dees; Hyman Muss; Trevor Jolly; Timothy M Zagar; Nirali Patel; C Ryan Miller; Joel S Parker; J Keith Smith; Julie Fisher; Nikita Shah; Lisle Nabell; Rita Nanda; Patrick Dillon; Vandana Abramson; Lisa A Carey; Carey K Anders Journal: Breast Cancer Res Treat Date: 2018-06-25 Impact factor: 4.872
Authors: José P Leone; Bjarni Haraldsson; Sarah L Mott; Bradley D McDowell; Elizabeth A Chrischilles Journal: Am J Clin Oncol Date: 2019-01 Impact factor: 2.339
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