Risk factors for breast cancer brain metastases: a systematic review
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Lola Koniali1,*, Andreas Hadjisavvas1,2,*, Anastasia Constantinidou3, Kyproula Christodoulou2,4, Yiolanda Christou5, Christiana Demetriou6, Andreas S. Panayides7, Constantinos Pitris8, Constantinos S. Pattichis7, Eleni Zamba-Papanicolaou2,5 and Kyriacos Kyriacou1,2
1 Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
2 The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
3 Medical School, University of Cyprus and the Bank of Cyprus Oncology Centre, Nicosia, Cyprus
4 Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
5 Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
6 Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
7 Department of Electrical and Computer Engineering, School of Engineering, University of Cyprus, Nicosia, Cyprus
8 Department of Computer Science, University of Cyprus, Nicosia, Cyprus
* These authors contributed equally to this work
Keywords: breast cancer; brain metastases; risk factors; biomarkers
Received: August 21, 2019 Accepted: January 04, 2020 Published: February 11, 2020
Background: Brain metastasis (BM) is an increasingly common and devastating complication of breast cancer (BC).
Methods: A systematic literature search of EMBASE and MEDLINE was conducted to elucidate the current state of knowledge on known and novel prognostic factors associated with 1) the risk for BCBM and 2) the time to brain metastases (TTBM).
Results: A total of 96 studies involving institutional records from 28 countries were identified. Of these, 69 studies reported risk factors of BCBM, 46 factors associated with the TTBM and twenty studies examined variables for both outcomes. Young age, estrogen receptor negativity (ER-), overexpression of human epidermal factor (HER2+), and higher presenting stage, histological grade, tumor size, Ki67 labeling index and nodal involvement were consistently found to be independent risk factors of BCBM. Of these, triple-negative BC (TNBC) subtype, ER-, higher presenting histological grade, tumor size, and nodal involvement were also reported to associate with shorter TTBM. In contrast, young age, hormone receptor negative (HR-) status, higher presenting stage, nodal involvement and development of liver metastasis were the most important risk factors for BM in HER2-positive patients.
Conclusions: The study provides a comprehensive and individual evaluation of the risk factors that could support the design of screening tools and interventional trials for early detection of BCBM.
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