TY - JOUR
T1 - Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms
AU - Cacho-Díaz, Bernardo
AU - Salmerón-Moreno, Karen
AU - Alvarez-Alvarez, Alejandra
AU - Mendoza-Olivas, Laura Georgina
AU - Alvarado-Miranda, Alberto
AU - Villarreal-Garza, Cynthia
AU - Reynoso-Noverón, Nancy
AU - Chávez-MacGregor, Mariana
AU - Meneses-García, Antelmo Abelardo
N1 - Publisher Copyright:
© 2020 American Cancer Society
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm). Methods: The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis. Results: Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P <.0001]), human epidermal growth factor receptor 2 (HER2)–positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P <.0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P <.001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P =.001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P <.0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months). Conclusions: CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases.
AB - Background: The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm). Methods: The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis. Results: Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P <.0001]), human epidermal growth factor receptor 2 (HER2)–positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P <.0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P <.001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P =.001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P <.0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months). Conclusions: CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases.
KW - brain metastasis
KW - breast cancer
KW - central nervous system metastasis
KW - neurologic symptoms
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=85085548725&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085548725&partnerID=8YFLogxK
U2 - 10.1002/cncr.32928
DO - 10.1002/cncr.32928
M3 - Article
C2 - 32453447
AN - SCOPUS:85085548725
SN - 0008-543X
VL - 126
SP - 3456
EP - 3463
JO - Cancer
JF - Cancer
IS - 15
ER -