Incidence, pattern and prognosis of brain metastases in patients with metastatic triple negative breast cancer

Abstract

Background: To identify the incidence, recurrence pattern and prognosis of brain metastases (BM) among women with metastatic triple negative breast cancer (mTNBC) treated consecutively at a single institution during a 7-year period.

Methods: Patients with histologically confirmed mTNBC were retrospectively identified. The incidence of BM as first site of recurrence and the cumulative BM incidence were computed. We used the Cox proportional hazards model to identify the univariate and multivariate factors associated with survival.

Results: Four hundred thirty three patients were included with a median overall survival (OS) of 21.6 months after median follow-up for 48.1 months. BM was found in 29% (127/433) of the patients and about a quarter (32/127) of BM was first recurrence. The cumulative incidence of BM at 1 and 2 years was 17 and 25%, respectively. The median time from the diagnosis of extracranial metastases to BM was 10 months. Median OS following a diagnosis of BM was 7.3 months. The longer median OS from time of first recurrent BM was noted compared with those of subsequent recurrent (17.3 vs 6.3 months, p = 0.008). However, patients with first recurrent BM were associated with shorter OS compared with those without BM (17.3 vs 22.1 months, p = 0.006). The independent factors that increased BM death risk were > 3 brain lesions, no BM-directed treatment, subsequent recurrent BM, symptomatic BM and uncontrolled extracranial metastasis.

Conclusions: Patients with mTNBC have a high incidence of early BM with subsequent poor survival. The findings lend support to consideration of screening imaging of the brain for mTNBC patients.

Keywords: Brain metastases; Prognosis; Recurrence pattern; Triple-negative breast cancer.

Fig. 1

Overall survival of patients with mTNBC. a Kaplan–Meier survival curve of 433 patients with mTNBC. b Kaplan–Meier survival curve of 127 patients with BM from TNBC. c Kaplan-Meier plots illustrating survival of patients had BM initially involved and those subsequently involved. The longer median survival from time of brain metastases diagnosis that is seen in the first recurrent BM compared with the subsequent recurrent BM (17.3 vs 6.3 months, p = 0.008). d Kaplan-Meier plots illustrating survival of patients with first BM recurrence presence and those absence. Patients with BM initial presence were associated with shorter OS (17.3 vs 22.1 months, p = 0.006)