TY - JOUR
T1 - Prognostic Factors and Survival Outcomes among Patients with Breast Cancer and Brain Metastases at Diagnosis
T2 - A National Cancer Database Analysis
AU - Zimmerman, Brittney S.
AU - Seidman, Danielle
AU - Cascetta, Krystal P.
AU - Ru, Meng
AU - Moshier, Erin
AU - Tiersten, Amy
N1 - Funding Information:
The authors wish to acknowledge the support of the Biostatistics Shared Resource Facility funded by the National Cancer Institute Cancer Center Support Grant P30CA196521-01 for analysis and interpretation of data and preparation of the manuscript.
Funding Information:
These are the financial relationships with industry reported by Dr. Amy Tiersten during 2019: Consulting: Immunomedics, As-traZeneca, Novartis, Elsai Inc, Cowen, Athenex; Research funding: Pfizer. The authors Brittney S. Zimmerman, Danielle Seidman, Krystal P. Cascetta, Meng Ru, and Erin Moshier have no conflicts of interest to declare.
Publisher Copyright:
© 2021 S. Karger AG. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Introduction: The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis. Methods: We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables. Results: In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race. Discussion/Conclusion: Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.
AB - Introduction: The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis. Methods: We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables. Results: In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race. Discussion/Conclusion: Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.
UR - http://www.scopus.com/inward/record.url?scp=85102126448&partnerID=8YFLogxK
U2 - 10.1159/000512212
DO - 10.1159/000512212
M3 - Article
C2 - 33652435
AN - SCOPUS:85102126448
SN - 0030-2414
VL - 99
SP - 280
EP - 291
JO - Oncology
JF - Oncology
IS - 5
ER -