Survival analysis of patients with brain metastases at initial breast cancer diagnosis over the last decade

• DOI: 10.1007/s10549-024-07290-1
• Publication Date: 2024-03-07T21:12:48Z
• Authors: Jorge Avila; Julieta Leone; Carlos T. Vallejo; Nancy U. Lin; José P. Leone
• Keywords: Adult; Pulmonary and Respiratory Medicine; Receptor, ErbB-2; Epidemiology; Advancements in Lung Cancer Research; Logistic regression; Breast Neoplasms; Kaplan-Meier Estimate; Proportional hazards model; Metastasis; 03 medical and health sciences; Small Cell Lung Cancer; 0302 clinical medicine; Breast cancer; Health Sciences; Humans; Biomarker Analysis; Internal medicine; Biology; Aged; Neoplasm Staging; Cancer; Brain Neoplasms; Brain metastasis; Paleontology; Middle Aged; Prognosis; Survival Analysis; Oncology; Multivariate analysis; Medicine; Female; Brain Metastases; Stage (stratigraphy); SEER Program; Management of Brain Metastases in Cancer Patients

Abstract Purpose: There have been significant advances in the treatment of metastatic breast cancer (BC) over the past years, and long-term outcomes after a diagnosis of brain metastases (BM) are lacking. We aimed to identify predictors of brain metastases at initial breast cancer diagnosis, describe overall survival (OS) in the past decade, and identify factors associated with OS after BM diagnosis. Methods: We evaluated patients with de novo stage IV BC using the Surveillance, Epidemiology and End Results database from 2010-2019. Multivariate logistic regression was conducted to assess predictors of brain metastases at initial breast cancer diagnosis. OS was estimated using the Kaplan-Meier method and log rank test was used to compare differences between groups. Cox regression was used to assess the associations of several variables with OS. Results: 1,939 patients with brain metastases at initial breast cancer diagnosis were included. Factors associated with this presentation were grade III/IV tumors, ductal histology, hormone receptor (HR)-negative/human epidermal growth factor receptor 2 (HER2)-positive subtype, and extracranial metastases. Patients with HR-positive/HER2-positive disease had the longest OS (median 18 months) and 12.2% were alive at 8 years. Factors associated with shorter OS included older age, lower income, triple-negative subtype, higher grade, and visceral metastases. Conclusion: Over the last decade, the median OS of brain metastases at initial breast cancer diagnosis remained poor; however, a substantial minority survive 5 or more years, with rates higher in patients with HER2-positive tumors. In addition to tumor subtype, OS varied according to age, extracranial metastases, and sociodemographic factors.