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Open Access Highly Accessed Research article

Identification of breast cancer patients with a high risk of developing brain metastases: a single-institutional retrospective analysis

Volker Rudat1*, Hamdan El-Sweilmeen2, Iris Brune-Erber3, Alaa Ahmad Nour1, Nidal Almasri4, Saleh Altuwaijri5 and Elias Fadel2

Author Affiliations

1 Department of Radiation Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia

2 Department of Haematology and Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia

3 Department of Surgery, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia

4 Department of Pathology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia

5 SAAD Research & Development Center, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia

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BMC Cancer 2014, 14:289  doi:10.1186/1471-2407-14-289

Published: 24 April 2014

Abstract

Background

The objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention.

Methods

Medical records of 352 breast cancer patients with local or locoregional disease at diagnosis were retrospectively analysed. The brain metastasis-free survival was estimated using the Kaplan-Meier method and patient groups were compared using the log rank test. The simultaneous relationship of multiple prognostic factors was assessed using Cox’s proportional hazard regression analysis. The Fisher exact test was used to test the difference of proportions for statistical significance.

Results

On univariate analysis, statistically highly significant unfavourable risk factors for the brain metastasis-free survival were negative ER status, negative PR status, and triple negative tumor subtype. Young age at diagnosis (≤35 years) and advanced disease stage were not statistically significant (p = 0.10). On multivariate analysis, the only independent significant factor was the ER status (negative ER status; hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). In the subgroup of 168 patients with a minimum follow-up of 24 months, 49 patients developed extracranial metastases as first metastatic event. Of those, 7 of 15 (46.6%) with a negative ER status developed brain metastases compared to 5 of 34 (14.7%) with a positive ER status (Fisher exact test, p = 0.03). The median time interval (minimum-maximum) between the diagnosis of extracranial and brain metastases was 7.5 months (1-30 months).

Conclusions

Breast cancer patients with extracranial metastasis and negative ER status exhibited an almost 50% risk of developing brain metastasis during their course of disease. Future studies are highly desired to evaluate the efficacy of pre-emptive medical intervention such as prophylactic treatment or diagnostic screening for high risk breast cancer patients.

Keywords:
Breast cancer; Brain metastasis; Progesterone receptor negative breast cancer