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Incidence of brain metastases as a first site of recurrence among women with triple receptor–negative breast cancer
Author(s) -
Dawood Shaheenah,
Lei Xiudong,
Litton Jennifer K.,
Buchholz Thomas A.,
Hortobagyi Gabriel N.,
GonzalezAngulo Ana M.
Publication year - 2012
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.27434
Subject(s) - medicine , cumulative incidence , incidence (geometry) , breast cancer , proportional hazards model , confidence interval , brain metastasis , stage (stratigraphy) , oncology , triple negative breast cancer , retrospective cohort study , cancer , surgery , metastasis , cohort , paleontology , physics , optics , biology
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.