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He DJ, Yu DQ, Wang QM, Yu ZY, Qi YH, Shao QJ, Chang H. Breast Cancer Subtypes and Mortality of Breast Cancer Patients With Brain Metastasis at Diagnosis: A Population-Based Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211055636. [PMID: 34789038 PMCID: PMC8619743 DOI: 10.1177/00469580211055636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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.
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Affiliation(s)
- Dong-Jie He
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - De-Quan Yu
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - Qi-Ming Wang
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - Zong-Yan Yu
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - Yu-Hong Qi
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - Qiu-Ju Shao
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
| | - Hao Chang
- Department of Radiation Oncology, Tangdu Hospital, 56697The Second Affiliated Hospital of Air Force Medical University, Xi'an, People's Republic of China
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Michel A, Oppong MD, Rauschenbach L, Pierscianek D, Dinger TF, Schmidt T, Hense J, Pöttgen C, Kimmig R, Ahmadipour Y, Özkan N, Müller O, Junker A, Sure U, Jabbarli R, El Hindy N. HER2 Receptor Conversion Is a strong Survival Predictor in Patients with Breast Cancer Brain Metastases. World Neurosurg 2021; 152:e332-e343. [PMID: 34062302 DOI: 10.1016/j.wneu.2021.05.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hormone and human epidermal growth factor receptor 2 (HER2/neu) receptor status is prognostic and predictive in breast cancer (BC) and guides the choice of therapy. However, owing to receptor conversion, the receptor status can differ in metastases compared with that of the primary tumor. The aim of the present study was to analyze the prognostic value of receptor status, receptor conversion, and clinical parameters in patients with resected BC brain metastases (BMs). METHODS Patients with BCBMs treated at our institution from July 2007 to December 2019 were eligible for the present study. The receptor status of the BC and corresponding BMs and the occurrence of receptor conversion were separately recorded for 3 common receptors: HER2/neu, estrogen receptor, and progesterone receptor. The association between the receptor status or receptor conversion and clinical parameters was adjusted for outcome-relevant patient and tumor characteristics. RESULTS The final analysis included 78 patients. HER2/neu receptor status in BMs was associated with overall survival (P = 0.033). Receptor conversion was identified in 39 patients (50.0%): HER2/neu, n = 9 (11.5%); estrogen receptor, n = 22 (28.2%); and progesterone receptor, n = 25 (32.1%). In the final multivariate Cox regression analysis, HER2/neu receptor conversion (adjusted hazard ratio [aHR], 3.58; P = 0.006), Karnofsky performance status score <70% (aHR, 3.11; P = 0.048), infratentorial BM location (aHR, 2.49; P = 0.007), and age ≥55 years at BM diagnosis (aHR, 2.20; P = 0.046) were independently associated with poorer survival. CONCLUSIONS Of the 3 common BC receptors, only HER2/neu receptor conversion was strongly associated with the prognosis of patients with surgically treated BCBMs. The clinical relevance of the reevaluation of receptor status in BMs favors surgical treatment of patients with noneloquent BCBMs.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Thiemo F Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Teresa Schmidt
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
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Wang JN, Yan FS, Xu Z, Sheng Y, Li HY. More dismal prognosis for breast cancer brain metastases? Real-world evidence from a SEER-based study. Clin Neurol Neurosurg 2018; 174:248-249. [PMID: 30220604 DOI: 10.1016/j.clineuro.2018.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/11/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jun-Nan Wang
- Basic Medical College, Navy Medical University, Shanghai 200433, China
| | - Feng-Shang Yan
- Basic Medical College, Navy Medical University, Shanghai 200433, China
| | - Zheng Xu
- Department of Academic Research, Navy Medical University, Shanghai 200433, China
| | - Yuan Sheng
- Department of Thyroid and Breast Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Heng-Yu Li
- Department of Thyroid and Breast Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China.
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Altundag K. Receptor conversion in breast cancer brain metastases may affect survival. Clin Neurol Neurosurg 2018; 171:194. [DOI: 10.1016/j.clineuro.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
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