Impact of Triple Negative Phenotype on Prognosis of Patients with Breast Cancer Brain Metastases following Gamma Knife Surgery

Keywords: breast cancer, gamma knife, brain metastasis, radiosurgery, outcome

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     Hormone status is important for breast cancer outcomes.
To evaluate the impact of triple-negative (TN) phenotype on prognosis following Gamma Knife Radiosurgery (GKS) for breast cancer patients with intracranial metastases.
     A total of 103 breast cancer patients with brain metastases treated at University of Virginia Gamma Knife Center between March 1996 and March 2011 were studied retrospectively. Twenty four (23.3%) patients were TN.
     Survival times were estimated using Kaplan-Meier method with a log-rank test computing the survival time difference between groups. Univariate and multivariate analyses to predict the potential prognostic factors were performed using the Cox proportional hazard regression model. A p value of less than 0.05 was deemed statistically significant.
     The presence of TN phenotype was associated with worsened survival times, including overall survival (OS) following the diagnosis of primary breast cancer (43 months vs. 82 months), neurological survival (NS) after the diagnosis of intracranial metastases and radiosurgical survival (RS) following GKS with median survival times being 13 months vs. 25 months, and 6 months vs. 16 months, respectively (p<0.002). On multivariate analysis, radiosurgical survival benefit was associated with non-TN status, HER2 overexpression, and lower RPA class at GKS, and total tumor number at GKS.
     This was a retrospective study.
     TN phenotype represents a significant adverse prognostic factor with respect to overall survival, neurological survival, and radiosurgical survival in breast cancer women with intracranial metastasis. HER2/neu overexpression and RPA remain also served as important and independent prognostic factors.
     Knowledge of hormone receptor status can affect management.


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