Incidence of brain metastases as a first site of recurrence among women with triple receptor–negative breast cancer

Authors

  • Shaheenah Dawood MRCP(UK) MPH,

    Corresponding author
    1. Department of Medical Oncology, Dubai Hospital, United Arab Emirates
    • Department of Medical Oncology, Dubai Hospital, Department of Health and Medical Services, P.O. Box 8179, Dubai, United Arab Emirates
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    • Telephone: 97150-7289797

  • Xiudong Lei PhD,

    1. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jennifer K. Litton MD,

    1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Thomas A. Buchholz MD,

    1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Gabriel N. Hortobagyi MD,

    1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Ana M. Gonzalez-Angulo MD, MSc

    Corresponding author
    1. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
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    • Fax: (713) 745-4385


Abstract

BACKGROUND:

This retrospective study sought to define the incidence of brain metastases as a first site of recurrence among women with triple receptor–negative breast cancer (TNBC).

METHODS:

A total of 2448 patients with stage I through III TNBC who were diagnosed between 1990 and 2010 were identified. We computed the cumulative incidence of developing brain metastases as a first site of recurrence at 2 and 5 years. Cox proportional hazards models were fitted to determine factors that could predict for the development of brain metastases as a first site of recurrence. The Kaplan-Meier product limit method was used to compute survival following a diagnosis of brain metastases.

RESULTS:

At a median follow-up of 39 months, 115 (4.7%) patients had developed brain metastases as a first site of recurrence. The cumulative incidence at 2 and 5 years was 3.7% (95% confidence interval [CI] = 2.9%-4.5%) and 5.4% (95% CI = 4.4%-6.5%), respectively. Among patients with stage I, II, and III disease, the 2-year cumulative incidence of brain metastases was 0.8%, 3.1%, and 8%, respectively (P < .0001). The 5-year cumulative incidence was 2.8%, 4.6%, and 9.6% among patients with stage I, II, and III disease, respectively (P < .0001). In the multivariable model, patients with stage III disease had a significant increase in the risk of developing brain metastases as a first site of recurrence (hazards ratio = 3.51; 95% CI = 1.85-6.67; P = .0001) compared to patients with stage I disease. Those with stage II disease had a nonsignificant increased risk of developing brain metastases as a first site of recurrence (hazards ratio = 1.61; 95% CI = 0.92-2.81; P = .10) compared with patients with stage I disease. Median survival following a diagnosis of brain metastases was 7.2 months (range, 5.7-9.4 months).

CONCLUSIONS:

Patients with nonmetastatic TNBC have a high early incidence of developing brain metastases as a first site of recurrence, which is associated with subsequent poor survival. Patients with stage III TNBC in particular would be an ideal cohort in which to research preventive strategies. Cancer 2012. © 2012 American Cancer Society.

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