Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.445
Peer-review started: September 7, 2023
First decision: September 20, 2023
Revised: September 29, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: November 24, 2023
Processing time: 76 Days and 1 Hours
Breast cancer (BC) has become the most common malignancy in women. The incidence and detection rates of BC brain metastasis (BCBM) have increased with the progress of imaging, multidisciplinary treatment techniques and the extension of survival time of BC patients. BM seriously affects the quality of life and sur-vival prognosis of BC patients. Therefore, clinical research on the clinicopathological features and prognostic factors of BCBM is valuable. By analyzing the clinicopathological parameters of BCBM patients, and assessing the risk factors and prognostic indicators, we can perform hierarchical diagnosis and treatment on the high-risk population of BCBM, and achieve clinical benefits of early diagnosis and treatment.
To explore the clinicopathological features and prognostic factors of BCBM, and provide references for diagnosis, treatment and management of BCBM.
The clinicopathological data of 68 BCBM patients admitted to the Air Force Medical Center, Chinese People’s Liberation Army (formerly Air Force General Hospital) from 2000 to 2022 were collected. Another 136 BC patients without BM were matched at a ratio of 1:2 based on the age and site of onset for retrospective analysis. Categorical data were subjected to χ2 test or Fisher’s exact probability test, and the variables with P < 0.05 in the univariate Cox proportional hazards model were incorporated into the multivariate model to identify high-risk factors and independent prognostic factors of BCBM, with a hazard ratio (HR) > 1 suggesting poor prognostic factors. The survival time of patients was estimated by the Kaplan–Meier method, and overall survival was compared between groups by log-rank test.
Multivariate Cox regression analysis showed that patients with stage III/IV tumor at initial diagnosis [HR: 5.58, 95% confidence interval (CI): 1.99–15.68], lung metastasis (HR: 24.18, 95%CI: 6.40–91.43), human epidermal growth factor receptor 2 (HER2)-overexpressing BC and triple-negative BC were more prone to BM. As can be seen from the prognostic data, 52 of the 68 BCBM patients had died by the end of follow-up, and the median time from diagnosis of BC to the occurrence of BM and from the occurrence of BM to death or last follow-up was 33.5 and 14 mo, respectively. It was confirmed by multivariate Cox regression analysis that patients with neurological symptoms (HR: 1.923, 95%CI: 1.005–3.680), with bone metastasis (HR: 2.011, 95%CI: 1.056-3.831), and BM of HER2-overexpressing and triple-negative BC had shorter survival time.
HER2-overexpressing, triple-negative BC, late tumor stage and lung metastasis are risk factors of BM. The presence of neurological symptoms, bone metastasis, and molecular type are influencing prognosis factors of BCBM.
Core Tip: We aimed to identify the high-risk factors of breast cancer brain metastasis (BCBM) and conducted prognostic analyses. Sixty-eight BCBM patients diagnosed and treated in the Air Force Medical Center in 2000–2022 were enrolled. Patients with human epidermal growth factor receptor 2 overexpressing and triple-negative breast cancer were more prone to BM and had shorter survival time. Late tumor stage and lung metastasis were independent risk factors for BM. The presence or absence of neurological symptoms and bone metastasis, and molecular type were independent prognostic factors for BCBM. Early screening of high-risk patients for BM helps improve survival rate.