Prognostic Factors in Therapy Regimes of Breast Cancer Patients with Brain Metastases: A Retrospective Monocentric Analysis
by
, , , ,
Carolin Julia Curtaz
1,*,
Judith Harms
1,
Constanze Schmitt
1,
Stephanie Tina Sauer
2,
Sara Aniki Christner
2,
Almuth Keßler
3,
Achim Wöckel
1,
Patrick Meybohm
4,
Malgorzata Burek
4,
Julia Feldheim
3 and
Jonas Feldheim
5 1
Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
2
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, 97080 Würzburg, Germany
3
Section Experimental Neurosurgery, Department of Neurosurgery, University Hospital Würzburg, 97080 Würzburg, Germany
4
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, 97080 Würzburg, Germany
5
Department of Neurology, University Hospital Nürnberg, Paracelsus Medical University, 90471 Nürnberg, Germany
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(2), 261; https://doi.org/10.3390/cancers17020261
Submission received: 14 November 2024
/
Revised: 6 January 2025
/
Accepted: 13 January 2025
/
Published: 15 January 2025
(This article belongs to the Special Issue Breast Cancer Brain Metastasis and Leptomeningeal Disease)
Simple Summary
Breast cancer patients who develop brain metastases (BMs) face high mortality rates and significant declines in quality of life. Despite its prevalence, knowledge about prognostic factors for brain metastases in breast cancer (BMBC) remains limited. This study analyzed data from 337 BMBC patients treated at our institute between 2004 and 2021. Findings revealed that regional lymph node involvement at the initial diagnosis, the triple-negative breast cancer subtype at BM onset, and extracranial metastases (bone, liver, lung) at the time of BM diagnosis were linked to worse prognoses. Conversely, the HER2/neu-positive subtype, a single BM, BM resection, and stereotactic radiotherapy were associated with prolonged survival. The number of therapies before BM diagnosis also influenced prognosis. Along with known predictors like BM count, extracranial metastases, and treatment modalities, factors such as prior therapies and initial lymph node status could be used in future prognostic models.
Abstract
Background: Breast cancer patients who develop brain metastases have a high mortality rate and a massive decrease in quality of life. Approximately 10–15% of all patients with breast cancer (BC) and 5–40% of all patients with metastatic BC develop brain metastasis (BM) during the course of the disease. However, there is only limited knowledge about prognostic factors in the treatment of patients with brain metastases in breast cancer (BMBC). Therefore, we retrospectively analyzed data of BMBC patients from the University Hospital of Würzburg for treatment patterns to find characteristics associated with a better or worse prognosis. These findings should help to treat the ever-increasing collective of patients with BMBC better in the future. Methods: The clinical data of 337 patients with cerebral metastatic breast cancer (date of death between 2004 and 2021) treated at the Department of Gynecology and Obstetrics of the University Hospital Würzburg were retrospectively analyzed, with a focus on patients’ survival. Results: The involvement of regional lymph nodes at initial diagnosis, the immunohistochemical subtype of TNBC at the onset of BMBC, and extracranial metastases at the time of BM diagnosis (bone, liver, lung metastases) were associated with a worse prognosis. In contrast, the immunohistochemical subtype of HER2/neu, the sole occurrence of a singular BM, the local surgical removal of BMs, and radiotherapy (especially stereotactic radiotherapy) were associated with prolonged survival. The number of therapies before the diagnosis of BMs also had a prognostic influence. Conclusions: Looking back at data is crucial for pinpointing risk elements affecting survival after a BM diagnosis. In our investigation, along with established factors like immunohistologic subtype, BM count, surgical excision, stereotactic irradiation, and type of extracranial metastasis, we also found that the number of therapies before BM diagnosis and the initial lymph node status were associated with patients’ survival. Potentially, these factors could be included in prospective prognostic scores for evaluating brain metastasis survival rates, thereby aiding in making appropriate treatment suggestions for impacted patients.
