Frequency Survey of Brain Metastases and Its Associated Factors Among Iranian Women with Breast Cancer: A Cross-sectional Study in Tehran City

Brain Metastases among BC Patients

Authors

  • Elham Sadeghi Moghimi Department of Community Health Nursing, Shiraz, Iran
  • Zeinab Ghanbari Department of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
  • Seyed Abbas Mirmalek Department of Surgery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
  • Kamkar Aeinfar Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Seyed Alireza Salimi Tabatabaee Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
  • Hamid Zaferani Arani Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
  • Amir Ghasemi Young Researchers and Elite Club, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
  • Ehsan Jangholi 1-Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran/ 2-Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  • Zahra Abbasy Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Rahimi Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Iran
  • Fereshteh Derayati Department of Stem Cells and Developmental Biology, Roudehen Branch, Islamic Azad University, Roudehen, Iran

DOI:

https://doi.org/10.31661/gmj.v13i.3238

Keywords:

Brain; Breast Cancer; Metastasis; Prognosis; Ki-67; Hormonal Receptor

Abstract

Background: Brain metastases are serious complication of breast cancer (BC) that poses a critical management challenge. Hence, this study aimed to evaluate clinical findings, the status of hormonal receptors, and their correlation with brain metastasis among patients with BC. Materials and Methods: This cross-sectional study was performed on women with BC that was newly diagnosed with brain metastasis from 2020 to 2023. Also, hormonal receptor status (such as p53, estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor2 [HER2]), histopathological type of BC, duration of disease, type of treatment, local cerebral invasions, and initial presentations were recorded. A P-value less than 0.05 was considered as statistical significance. Results: Of a total of 302 patients, 49 (16.2%) patients had brain metastasis. The mean age of patients was 45.21±8.3 years, which was significantly lower in patients with metastasis (45.96±11.31 vs. 51.13±12.61 years, P=0.008). There was a significant association between the duration of disease in patients with and without brain metastasis (2.76±1.03 vs. 5.55±3.32 years, P=0.002). Also, the most prevalent histopathological type of BC was invasive ductal carcinoma (IDC). Headache was the most common clinical presentation among patients with brain metastasis. In addition, the most and the least common positive receptors among patients with metastasis were Ki-67 (93.87%) and PR (55.1%), respectively. Compared to patients without metastasis, HER2-positive and P53-positive receptors were markedly associated with brain metastasis (P=0.03 and P=0.021, respectively). However, there was no significant association between treatment methods and metastasis status.Conclusion: Patients with younger age, IDC, and positivity of HER2 and P53 receptors were at an increased risk of developing brain metastases.

References

Mirmalek SA, Elhamkani F, Salimi Tabatabaee SA, Mahmoodzadeh H, Parsa Y, Yadollah-Damavandi S, et al. Introduction of HER-2 and a Short Review on Its Role in Prognosis and Treatment of Breast Cancer. Galen Med J. 2014;3(3):132-44.

https://doi.org/10.31661/gmj.v3i3.318

Aalipour E, Jangholi E. Prognosis and Predictive Factors Related to Breast Cancer. Galen Medical Journal 2016;5(2):45-8.

https://doi.org/10.31661/gmj.v5i2.644

DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer statistics, 2013. CA Cancer J Clin. 2014;64(1):52-62.

https://doi.org/10.3322/caac.21203

PMid:24114568

Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women's cancers: a grand challenge in global health. Lancet. 2017;389(10071):847-60.

https://doi.org/10.1016/S0140-6736(16)31392-7

PMid:27814965

Mirmalek SA, Azizi MA, Jangholi E, Yadollah-Damavandi S, Javidi MA, Parsa Y, et al. Cytotoxic and apoptogenic effect of hypericin, the bioactive component of Hypericum perforatum on the MCF-7 human breast cancer cell line. Cancer Cell Int. 2016;16:3.

https://doi.org/10.1186/s12935-016-0279-4

PMid:26865836 PMCid:PMC4748624

Tayyeb B, Parvin M. Pathogenesis of breast cancer metastasis to brain: a comprehensive approach to the signaling network. Mol Neurobiol 2016;53:446-54.

https://doi.org/10.1007/s12035-014-9023-z

PMid:25465242

Parsa Y, Mirmalek SA, Kani FE, Aidun A, Salimi-Tabatabaee SA, Yadollah-Damavandi S, et al. A Review of the Clinical Implications of Breast Cancer Biology. Electron Physician. 2016;8(5):2416-24.

https://doi.org/10.19082/2416

PMid:27382453 PMCid:PMC4930263

Leone BA, Leone JP. Breast cancer brain metastases: the last frontier. Exp Hematol Oncol. 2015:4:33.

https://doi.org/10.1186/s40164-015-0028-8

PMid:26605131 PMCid:PMC4657380

Lombardi G, Di Stefano AL, Farina P, Zagonel V, Tabouret E. Systemic treatments for brain metastases from breast cancer, non-small cell lung cancer, melanoma and renal cell carcinoma: an overview of the literature. Cancer Treat Rev. 2014;40:951-9.

https://doi.org/10.1016/j.ctrv.2014.05.007

PMid:24909312

Niikura N, Hayashi N, Masuda N, Takashima S, Nakamura R, Watanabe K-i, et al. Treatment outcomes and prognostic factors for patients with brain metastases from breast cancer of each subtype: a multicenter retrospective analysis. Breast Cancer Res Treat. 2014;147(1):103-12.

https://doi.org/10.1007/s10549-014-3090-8

PMid:25106661

Niikura N, Saji S, Tokuda Y, Iwata H. Brain metastases in breast cancer. Jpn J Clin Oncol. 2014;44:1133-40.

https://doi.org/10.1093/jjco/hyu156

PMid:25320339

Lee JY, Park K, Lee E, Ahn T, Jung HH, Lim SH, et al. Gene expression profiling of breast cancer brain metastasis. Sci Rep. 2016:6:28623.

https://doi.org/10.1038/srep28623

PMid:27340107 PMCid:PMC4919653

Custódio-Santos T, Videira M, Brito MA. Brain metastasization of breast cancer. Biochim Biophys Acta Rev Cancer. 2017;1868(1):132-47.

https://doi.org/10.1016/j.bbcan.2017.03.004

PMid:28341420

Ginter AC. The linked lives of young women with metastatic breast cancer. J Psychosoc Oncol. 2022;40(2):169-83.

https://doi.org/10.1080/07347332.2021.1914269

PMid:33900892

Arvold ND, Oh KS, Niemierko A, Taghian AG, Lin NU, Abi-Raad RF, et al. Brain metastases after breast-conserving therapy and systemic therapy: incidence and characteristics by biologic subtype. Breast Cancer Res Treat. 2012;136(1):153-60.

https://doi.org/10.1007/s10549-012-2243-x

PMid:22968656

Chen M-T, Sun H-F, Zhao Y, Fu W-Y, Yang L-P, Gao S-P, et al. Comparison of patterns and prognosis among distant metastatic breast cancer patients by age groups: a SEER population-based analysis. Sci Rep. 2017;7(1):9254.

https://doi.org/10.1038/s41598-017-10166-8

PMid:28835702 PMCid:PMC5569011

Rostami R, Mittal S, Rostami P, Tavassoli F, Jabbari B. Brain metastasis in breast cancer: a comprehensive literature review. J Neurooncol. 2016;127(3):407-14.

https://doi.org/10.1007/s11060-016-2075-3

PMid:26909695

Saunus JM, McCart Reed AE, Lim ZL, Lakhani SR. Breast Cancer Brain Metastases: Clonal Evolution in Clinical Context. Int J Mol Sci. 2017;18(1):152.

https://doi.org/10.3390/ijms18010152

PMid:28098771 PMCid:PMC5297785

Müller S, Köhler F, Hendricks A, Kastner C, Börner K, Diers J, et al. Brain Metastases from Colorectal Cancer: A Systematic Review of the Literature and Meta-Analysis to Establish a Guideline for Daily Treatment. Cancers (Basel). 2021;13(4):900.

https://doi.org/10.3390/cancers13040900

PMid:33669974 PMCid:PMC7924831

Knier NN, Hamilton AM, Foster PJ. Comparing the fate of brain metastatic breast cancer cells in different immune compromised mice with cellular magnetic resonance imaging. Clin Exp Metastasis. 2020;37(4):465-75.

https://doi.org/10.1007/s10585-020-10044-0

PMid:32533389

Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer. 2006;107(4):696-704.

https://doi.org/10.1002/cncr.22041

PMid:16826579

Li R, Zhang K, Siegal GP, Wei S. Clinicopathological factors associated with survival in patients with breast cancer brain metastasis. Hum Pathol. 2017:64:53-60.

https://doi.org/10.1016/j.humpath.2017.03.022

PMid:28428107

Hedayatizadeh-Omran A, Rafiei A, Alizadeh-Navaei R, Tehrani M, Valadan R, Moradzadeh K, et al. Role of HER2 in brain metastasis of breast cancer: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2015;16(4):1431-4.

https://doi.org/10.7314/APJCP.2015.16.4.1431

PMid:25743811

Koniali L, Hadjisavvas A, Constantinidou A, Christodoulou K, Christou Y, Demetriou C, et al. Risk factors for breast cancer brain metastases: a systematic review. Oncotarget. 2020;11(6):650-69.

https://doi.org/10.18632/oncotarget.27453

PMid:32110283 PMCid:PMC7021234

Yang H, Wang R, Zeng F, Zhao J, Peng S, Ma Y, et al. Impact of molecular subtypes on metastatic behavior and overall survival in patients with metastatic breast cancer: A single‑center study combined with a large cohort study based on the Surveillance, Epidemiology and End Results database. Oncol Lett. 2020;20(4):87.

https://doi.org/10.3892/ol.2020.11948

PMid:32863920 PMCid:PMC7436893

Kaidar-Person O, Meattini I, Jain P, Bult P, Simone N, Kindts I, et al. Discrepancies between biomarkers of primary breast cancer and subsequent brain metastases: an international multicenter study. Breast Cancer Res Treat. 2018;167(2):479-83.

https://doi.org/10.1007/s10549-017-4526-8

PMid:28975433

Wu Q, Li J, Zhu S, Wu J, Chen C, Liu Q, et al. Breast cancer subtypes predict the preferential site of distant metastases: a SEER based study. Oncotarget. 2017;8(17):27990-6.

https://doi.org/10.18632/oncotarget.15856

PMid:28427196 PMCid:PMC5438624

Fan Y, Wang Y, He L, Imani S, Wen Q. Clinical features of patients with HER2-positive breast cancer and development of a nomogram for predicting survival. ESMO Open. 2021;6(4):100232.

https://doi.org/10.1016/j.esmoop.2021.100232

PMid:34392135 PMCid:PMC8371219

Matsuo S, Watanabe J, Mitsuya K, Hayashi N, Nakasu Y, Hayashi M. Brain metastasis in patients with metastatic breast cancer in the real world: a single-institution, retrospective review of 12-year follow-up. Breast Cancer Res Treat. 2017;162(1):169-79.

https://doi.org/10.1007/s10549-017-4107-x

PMid:28084583

Koo T, Kim IA. Brain metastasis in human epidermal growth factor receptor 2-positive breast cancer: from biology to treatment. Radiat Oncol J. 2016;34(1):1-9.

https://doi.org/10.3857/roj.2016.34.1.1

PMid:27104161 PMCid:PMC4831963

Yuan P, Gao S-L. Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer. Chronic Dis Transl Med. 2017;3(1):21-32.

https://doi.org/10.1016/j.cdtm.2017.01.004

PMid:29063053 PMCid:PMC5627687

Aziz S, Pervez S, Khan S, Kayani N, Rahbar M. Relationship of p53 expression with clinicopathological variables and disease outcome: A prospective study on 315 consecutive breast carcinoma patients. Malays J Pathol. 2001;23(2):65-71.

Sadighi S, Zokaasadi M, Kasaeian A, Maghsudi S, Jahanzad I, Fumani HK. The effect of immunohistochemically detected p53 accumulation in prognosis of breast cancer; A retrospective survey of outcome. PLoS One. 2017;12(8):e0182444.

https://doi.org/10.1371/journal.pone.0182444

PMid:28771563 PMCid:PMC5542560

Tazhibi M, Fayaz M, Mokarian F. Detection of prognostic factors in metastatic breast cancer. J Res Med Sci. 2013;18(4):283-90.

Ziaei JE, Pourzand A, Bayat A, Vaez J. Patterns of metastasis and survival in breast cancer patients: a preliminary study in an Iranian population. Asian Pac J Cancer Prev. 2012;13(3):937-40.

https://doi.org/10.7314/APJCP.2012.13.3.937

PMid:22631675

Khandani BK, Tavakkoli L, Khanjani N. Metastasis and its Related Factors in Female Breast Cancer Patients in Kerman, Iran. Asian Pac J Cancer Prev. 2017;18(6):1567-71.

Payandeh M, Sadeghi M, Sadeghi E, Madani S-H. Expression of p53 breast cancer in Kurdish women in the West of Iran: a reverse correlation with lymph node metastasis. Asian Pac J Cancer Prev. 2016;17(3):1261-4.

https://doi.org/10.7314/APJCP.2016.17.3.1261

PMid:27039757

Tsao MN. Brain metastases: advances over the decades. Ann Palliat Med. 2015;4(4):225-32.

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Published

2024-02-25

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Vol. 13 (2024): 2024: In Progress

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Original Article

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