Prognostic factors of breast cancer brain metastasis

Abstract

In this editorial we comment on the article by Chen et al published in the recent issue of the World Journal of Clinical Oncology. Brain metastasis is one of the most serious complications of breast cancer and causes high morbidity and mortality. Brain metastases may involve the brain parenchyma and/or leptomeninges. Symptomatic brain metastases develop in 10%-16% of newly recognized cases each year, and this rate increases to 30% in autopsy series. Depending on the size of the metastatic foci, it may be accompanied by extensive vasogenic edema or may occur as small tumor foci. Since brain metastases are a significant cause of morbidity and mortality, early diagnosis can have significant effects on survival and quality of life. The risk of developing brain metastases emerges progressively due to various patient and tumor characteristics. Patient variability may be particularly important in the susceptibility and distribution of brain metastases because malignant blood must cross the brain barrier and move within the brain parenchyma. Some characteristics of the tumor, such as gene expression, may increase the risk of brain metastasis. Clinical growth, tumor stage, tumor grade, growth receptor positivity, HER2 positivity, molecular subtype (such as triple negative status, luminal/nonluminal feature) increase the risk of developing breast cancer metastasis. Factors related to survival due to breast cancer brain metastasis include both tumor/patient characteristics and treatment characteristics, such as patient age, lung metastasis, surgery for brain metastasis, and HER2 positivity. If cases with a high risk of developing brain metastasis can be identified with the help of clinical procedures and artificial intelligence, survival and quality of life can be increased with early diagnosis and treatment. At the same time, it is important to predict the formation of this group in order to develop new treatment methods in cases with low survival expectancy with brain metastases.

Keywords: Breast cancer; Brain metastasis; Prognosis; Artificial intelligence; Clinicopathological features

Core Tip: Breast cancer is still the most common cancer in women. Breast cancer is the second most common cancer causing brain metastasis. In breast cancer, the first metastasis occurs to the brain with a rate of 12%. In recent years, the prognosis of breast cancer-related brain metastases has improved, and survival and the patient's quality of life have increased, thanks to both changes in medical treatments and technological advances in radiotherapy. For this reason, early diagnosis of cases is very important. At the same time, survival is not the same in every case of brain metastasis. Identifying cases with low survival seems to be very important in paving the way for studies to change treatment strategies.