Journal of neuro-oncology · 2026
Prognostic impact of concomitant leptomeningeal disease in breast cancer patients with brain metastases: a large single-center cohort study.
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Benítez-Rocha Romina D, Cabrera-Galeana Paula, Reyes Juan A, Villaseñor-Navarro Yolanda, Arrieta Oscar, Navarro-Fernandez José Omar, Aboud Orwa, González-Aguilar Alberto, Cacho-Díaz Bernardo
Аннотация
BACKGROUND: Central nervous system (CNS) metastases are a frequent and ominous scenario in patients with breast cancer. CNS metastases (CNSm) are typically classified as brain metastases (BrMs) or leptomeningeal disease (LMD). Although the coexistence of BrMs and LMD (BrMs + LMD) is commonly encountered in clinical practice, its true prevalence and prognostic implications remain insufficiently characterized. This study aimed to characterize the distribution of CNSm and compare outcomes in patients with breast cancer BrMs with and without LMD.
METHODS: We retrospectively analyzed a prospectively maintained database of patients with breast cancer and magnetic resonance imaging (MRI)-confirmed CNSm treated at a single tertiary cancer center between January 2010 and January 2023.
RESULTS: Among 659 patients with breast cancer CNSm, 292 (44%) had BrMs, 169 (26%) had LMD, and 198 (30%) had BrMs + LMD. The CNSm survival for the entire cohort was 9.6 months (95% CI, 8.0-11.2); 12.2 months (95% CI, 9.9-14.5) in the BrMs group; 5.8 months (95% CI, 4.3-7.2) in the LMD group; and 10.3 months (95% CI, 8.0-12.7 months) in the BrMs + LMD group (P < 0.001). After adjustment for performance status, number of brain metastases, and molecular subtype, the risk of mortality remained higher in the BrMs + LMD group (HR 1.24; 95% CI, 1.01-1.52; P = 0.032) compared with the BrMs group.
CONCLUSION: In patients with breast cancer and brain metastases, concomitant leptomeningeal involvement is common and independently associated with worse survival. These findings support the need to incorporate leptomeningeal disease status into prognostic models and clinical decision-making for CNSm in patients with breast cancer.
METHODS: We retrospectively analyzed a prospectively maintained database of patients with breast cancer and magnetic resonance imaging (MRI)-confirmed CNSm treated at a single tertiary cancer center between January 2010 and January 2023.
RESULTS: Among 659 patients with breast cancer CNSm, 292 (44%) had BrMs, 169 (26%) had LMD, and 198 (30%) had BrMs + LMD. The CNSm survival for the entire cohort was 9.6 months (95% CI, 8.0-11.2); 12.2 months (95% CI, 9.9-14.5) in the BrMs group; 5.8 months (95% CI, 4.3-7.2) in the LMD group; and 10.3 months (95% CI, 8.0-12.7 months) in the BrMs + LMD group (P < 0.001). After adjustment for performance status, number of brain metastases, and molecular subtype, the risk of mortality remained higher in the BrMs + LMD group (HR 1.24; 95% CI, 1.01-1.52; P = 0.032) compared with the BrMs group.
CONCLUSION: In patients with breast cancer and brain metastases, concomitant leptomeningeal involvement is common and independently associated with worse survival. These findings support the need to incorporate leptomeningeal disease status into prognostic models and clinical decision-making for CNSm in patients with breast cancer.