Breast Cancer with Brain Metastases: Risk Factors and Survival
Qi Shen, Nuhad K Ibrahim, Kenneth D Aldape, Aysegul Sahin. University of Texas MD Anderson Cancer Center, Houston, TX
Background: The aim of our study was to identify clinicopathologic parameters associated with increased risk for breast cancer brain metastases (BCBM) and to assess survival rates after treatment for BCBM.
Design: We retrospectively analyzed clinicopathologic data from 142 patients who had been histologically diagnosed as having BCBM between 2002 to 2009 at The University of Texas MD Anderson Cancer Center.
Results: The median age at diagnosis of breast cancer was 46 years (range, 24-73 years). Most patients had invasive ductal histology (91%), grade 3 tumors (68%), and positive axillary lymph nodes (64%). A total of 56% of the tumors were estrogen receptor (ER)-negative, 45% were Her2 positive, and 27% were triple negative (TN). Brain metastasis was solitary in 52% of patients. The median interval from breast cancer diagnoses to brain metastases was 46 months (range, 0-266 months), and the overall median survival duration after brain metastases was 14.5 months (range, 0-107 months). Overall median survival times were shorter for ER-negative (11 months) than for ER-positive (24.5 months) patients and were shorter for TN (9 months) than for non-TN (18 months) patients. Patients who were Her2-positive lived longer than did those with Her2-negative disease (17 months versus 11 months). Biomarkers were evaluated in paired primary tumors and brain metastases in 36 patients for ER status, in 34 patients for progesterone receptor (PR) status, and in 39 patients for Her2 status. Her2 expression was highly concordant (90% concordance rate) between the breast and brain tumors, and altered expression was noted in 28% of pairs for ER and in 20% of pairs for PR. Three patients with Her2-positive primary tumors had Her2-negative brain metastases, and only one patient with a Her2-negative breast carcinoma developed a Her2-positive brain tumor.
Conclusions: Patients with ER-negative, Her-2-positive and TN breast cancers were more likely to develop BCBM. Expression of breast cancer biomarkers did not differ significantly between the primary breast tumors and the corresponding brain metastases.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 39, Monday Morning