Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2023; 14(11): 445-458
Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.445
Analysis of clinicopathological features and prognostic factors of breast cancer brain metastasis
Yu-Rui Chen, Zu-Xin Xu, Li-Xin Jiang, Zhi-Wei Dong, Peng-Fei Yu, Zhi Zhang, Guo-Li Gu
Yu-Rui Chen, Li-Xin Jiang, Department of General Surgery, Air Force Clinical College, China Medical University, Beijing 100142, China
Zu-Xin Xu, Guo-Li Gu, Department of General Surgery, Fifth Clinical College (Air Force Clinical College) of Anhui Medical University, Beijing 100142, China
Zhi-Wei Dong, Peng-Fei Yu, Zhi Zhang, Guo-Li Gu, Department of General Surgery, Air Force Medical Center, Air Force Clinical College of China Medical University, Beijing 100142, China
Co-first authors: Yu-Rui Chen and Zu-Xin Xu.
Author contributions: Chen YR and Xu ZX contributed equally to this study, and share joint first authorship; Gu GL designed the research; Chen YR and Xu ZX conceived the study, developed the methodology, collected data, analyzed and interpreted data, and wrote the manuscript; Jiang LX, Zhang Z, Yu PF and Dong ZW collected and analyzed the clinical data; Gu GL and Dong ZW provided the material support, and revised the manuscript. All authors reviewed the results and approved the final version of the manuscript.
Supported by Outstanding Young Talents Program of Air Force Medical Center, PLA, No. 22BJQN004; Clinical Program of Air Force Medical University, No. Xiaoke2022-07.
Institutional review board statement: The study was approved by the ethics committee of the Air Force Medical Center, Chinese People's Liberation Army (Beijing, China).
Informed consent statement: Consent was obtained from patients or their relatives for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author kzggl@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Li Gu, Doctor, MD, Chief Doctor, Department of General Surgery, Air Force Medical Center, Air Force Clinical College of China Medical University, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. kzggl@163.com
Received: September 7, 2023
Peer-review started: September 7, 2023
First decision: September 20, 2023
Revised: September 29, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: November 24, 2023
Processing time: 76 Days and 1 Hours
Abstract
BACKGROUND

Breast cancer (BC) has become the most common malignancy in women. The incidence and detection rates of BC brain metastasis (BCBM) have increased with the progress of imaging, multidisciplinary treatment techniques and the extension of survival time of BC patients. BM seriously affects the quality of life and sur-vival prognosis of BC patients. Therefore, clinical research on the clinicopathological features and prognostic factors of BCBM is valuable. By analyzing the clinicopathological parameters of BCBM patients, and assessing the risk factors and prognostic indicators, we can perform hierarchical diagnosis and treatment on the high-risk population of BCBM, and achieve clinical benefits of early diagnosis and treatment.

AIM

To explore the clinicopathological features and prognostic factors of BCBM, and provide references for diagnosis, treatment and management of BCBM.

METHODS

The clinicopathological data of 68 BCBM patients admitted to the Air Force Medical Center, Chinese People’s Liberation Army (formerly Air Force General Hospital) from 2000 to 2022 were collected. Another 136 BC patients without BM were matched at a ratio of 1:2 based on the age and site of onset for retrospective analysis. Categorical data were subjected to χ2 test or Fisher’s exact probability test, and the variables with P < 0.05 in the univariate Cox proportional hazards model were incorporated into the multivariate model to identify high-risk factors and independent prognostic factors of BCBM, with a hazard ratio (HR) > 1 suggesting poor prognostic factors. The survival time of patients was estimated by the Kaplan–Meier method, and overall survival was compared between groups by log-rank test.

RESULTS

Multivariate Cox regression analysis showed that patients with stage III/IV tumor at initial diagnosis [HR: 5.58, 95% confidence interval (CI): 1.99–15.68], lung metastasis (HR: 24.18, 95%CI: 6.40–91.43), human epidermal growth factor receptor 2 (HER2)-overexpressing BC and triple-negative BC were more prone to BM. As can be seen from the prognostic data, 52 of the 68 BCBM patients had died by the end of follow-up, and the median time from diagnosis of BC to the occurrence of BM and from the occurrence of BM to death or last follow-up was 33.5 and 14 mo, respectively. It was confirmed by multivariate Cox regression analysis that patients with neurological symptoms (HR: 1.923, 95%CI: 1.005–3.680), with bone metastasis (HR: 2.011, 95%CI: 1.056-3.831), and BM of HER2-overexpressing and triple-negative BC had shorter survival time.

CONCLUSION

HER2-overexpressing, triple-negative BC, late tumor stage and lung metastasis are risk factors of BM. The presence of neurological symptoms, bone metastasis, and molecular type are influencing prognosis factors of BCBM.

Keywords: Breast cancer; Brain metastasis; Clinicopathological features; High-risk factors; Prognostic analysis

Core Tip: We aimed to identify the high-risk factors of breast cancer brain metastasis (BCBM) and conducted prognostic analyses. Sixty-eight BCBM patients diagnosed and treated in the Air Force Medical Center in 2000–2022 were enrolled. Patients with human epidermal growth factor receptor 2 overexpressing and triple-negative breast cancer were more prone to BM and had shorter survival time. Late tumor stage and lung metastasis were independent risk factors for BM. The presence or absence of neurological symptoms and bone metastasis, and molecular type were independent prognostic factors for BCBM. Early screening of high-risk patients for BM helps improve survival rate.