Brain metastases free survival differs between breast cancer subtypes

A Berghoff, Z Bago-Horvath, C De Vries, P Dubsky, U Pluschnig, M Rudas, A Rottenfusser, M Knauer, H Eiter, F Fitzal, K Dieckmann, R M Mader, M Gnant, C C Zielinski, G G Steger, M Preusser, R Bartsch, A Berghoff, Z Bago-Horvath, C De Vries, P Dubsky, U Pluschnig, M Rudas, A Rottenfusser, M Knauer, H Eiter, F Fitzal, K Dieckmann, R M Mader, M Gnant, C C Zielinski, G G Steger, M Preusser, R Bartsch

Abstract

Background: Brain metastases (BM) are frequently diagnosed in patients with HER-2-positive metastatic breast cancer; in addition, an increasing incidence was reported for triple-negative tumours. We aimed to compare brain metastases free survival (BMFS) of breast cancer subtypes in patients treated between 1996 until 2010.

Methods: Brain metastases free survival was measured as the interval from diagnosis of extracranial breast cancer metastases until diagnosis of BM. HER-2 status was analysed by immunohistochemistry and reanalysed by fluorescent in situ hybridisation if a score of 2+ was gained. Oestrogen-receptor (ER) and progesterone-receptor (PgR) status was analysed by immunohistochemistry. Brain metastases free survival curves were estimated with the Kaplan-Meier method and compared with the log-rank test.

Results: Data of 213 patients (46 luminal/124 HER-2/43 triple-negative subtype) with BM from breast cancer were available for the analysis. Brain metastases free survival differed significantly between breast cancer subtypes. Median BMFS in triple-negative tumours was 14 months (95% CI: 11.34-16.66) compared with 18 months (95% CI: 14.46-21.54) in HER-2-positive tumours (P=0.001) and 34 months (95% CI: 23.71-44.29) in luminal tumours (P=0.001), respectively. In HER-2-positive patients, co-positivity for ER and HER-2 prolonged BMFS (26 vs 15 m; P=0.033); in luminal tumours, co-expression of ER and PgR was not significantly associated with BMFS. Brain metastases free survival in patients with lung metastases was significantly shorter (17 vs 21 months; P=0.014).

Conclusion: Brain metastases free survival in triple-negative breast cancer, as well as in HER-2-positive/ER-negative, is significantly shorter compared with HER-2/ER co-positive or luminal tumours, mirroring the aggressiveness of these breast cancer subtypes.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates for BMFS. Median BMFS in triple-negative subtype was 14 months (95% CI: 11.34–16.66) compared with 18 months (95% CI: 14.46–21.54) in HER-2 subtype and 34 months (95% CI: 23.71–44.29) in luminal subtype (P=0.001, log-rank test).
Figure 2
Figure 2
Kaplan–Meier estimates for BMFS. Median BMFS in patients with the presence of lung metastases was 17 months (95% CI: 14.10–19.90) compared with 21 months (95% CI: 15.45–26.55) in patients with no evidence of lung metastases (P=0.014, log-rank test).
Figure 3
Figure 3
Kaplan–Meier estimates for BMFS. Median BMFS in HER-2/ER co-positive patients was 26 months (95% CI: 16.40–35.60) compared to (15 months; 95% CI: 10.77–19–23) in patients with HER-2-positive/ER-negative disease (P=0.033, log-rank test).

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Source: PubMed

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