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. 2018 Sep;144(9):1803-1816.
doi: 10.1007/s00432-018-2697-2. Epub 2018 Jul 3.

Molecular subtype predicts incidence and prognosis of brain metastasis from breast cancer in SEER database

Yi-Jun Kim  1   2 , Jae-Sung Kim  1 , In Ah Kim  3
Affiliations

Molecular subtype predicts incidence and prognosis of brain metastasis from breast cancer in SEER database

Yi-Jun Kim et al. J Cancer Res Clin Oncol. 2018 Sep.

Abstract

Purpose: To evaluate the impact of molecular subtype on incidence and prognosis of brain metastasis from breast cancer.

Methods: The Surveillance, Epidemiology, and End Results (SEER) 18 registry was used to select breast cancer patients from 2010 to 2014. Molecular subtypes were classified as luminal A (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-), luminal B (HR+/HER2+), HER2 (HR-/HER2+), or triple negative breast cancer (TNBC) (HR-/HER2-). The incidence and prognosis of brain metastasis was evaluated according to molecular subtype.

Results: Among the 206913 breast cancer patients, the HER2 subtype showed the highest incidence of brain metastasis (1.0%). HER2 and TNBC with multiple extracranial metastases (bone, liver, and lung) showed a high incidence of brain metastasis (28.0 and 30.8%, respectively). Median survival of luminal A, luminal B, HER2, and TNBC in brain metastasis was 12, 23, 10, and 6 months (p < 0.001), and in brain metastasis without visceral metastasis was 14, 34, 17, and 8 months (p < 0.001). On multivariate analysis, the order of subtype by favorable prognosis was luminal B, luminal A, HER2, and TNBC in all brain metastasis, while for brain metastasis patients without visceral metastasis, the order was luminal B, HER2, luminal A, and TNBC.

Conclusions: Molecular subtype and visceral metastasis should be considered for prediction of prognosis for patients with brain metastasis. The patients with HER2 and TNBC cancer subtypes having visceral metastasis, close surveillance could contribute to early detection of brain metastasis and may putatively lead to improved quality of life and survival.

Keywords: Brain metastasis; Breast cancer; Incidence; Molecular subtype; Prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Nomogram predicting the probability of brain metastasis at the time of breast cancer diagnosis. Lum A, luminal A; Lum B, luminal B; HER2, human epidermal growth factor receptor 2; TNBC, triple negative breast cancer
Fig. 2
Fig. 2
Kaplan–Meier survival curves according to molecular subtype in all patients with brain metastasis from breast cancer. a Covariate-unadjusted and b covariate-adjusted Kaplan–Meier survival graphs stratified by molecular subtype after adjusting for age, surgery, chemotherapy, radiotherapy, bone, lung, and liver metastases. HER2, human epidermal growth factor receptor 2; TNBC, triple negative breast cancer. *Log-rank test, **Cox multivariate regression analysis
Fig. 3
Fig. 3
Kaplan–Meier survival curves according to molecular subtype in patients with brain metastasis from breast cancer without visceral (lung and liver) metastasis. a Covariate-unadjusted and b Covariate-adjusted Kaplan–Meier survival graphs stratified by molecular subtype after adjusting for age, surgery, chemotherapy, radiotherapy, and bone metastasis. HER2, human epidermal growth factor receptor 2; TNBC, triple negative breast cancer. *Log-rank test, **Cox multivariate regression analysis
See this image and copyright information in PMC

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