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Meningism as a poor risk factor in breast cancer patients with relapse in central nervous system (CNS).

2012; Lippincott Williams & Wilkins; Volume: 30; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2012.30.15_suppl.e11518

1527-7755

Luis J. Schwarz, Carlos Vallejos, Silvia P. Neciosup, Joseph A. Pinto, Tatiana Vidaurre, G. Ferreyros, Henry Gómez,

Lung Cancer Research Studies

e11518 Background: CNS relapse in breast cancer patients is invariably defined as a poor prognosis feature with varied and bizarre clinical presentation. We describe the commonest signs and symptoms in CNS relapse and their relation with prognosis Methods: We evaluate retrospectively 2597 women with breast cancer treated at the Instituto Nacional de Enfermedades Neoplásicas (Lima-Perú) between 2000-2005. Phenotypes were determined by IHC and categorized in [HR+, HER2-], triple-negative (TN) [HR-, HER2-] and Her-2 [HR+/-, HER2 +]. Post-CNS recurrence survival was calculated by Kaplan Meier method. We use Chi-square, or exact Fisher test when appropriate, to evaluate correlations between categorical variables. Results: 157 pts (6.04%) had CNS relapse from which 19 had only leptomeningeal carcinomatosis (LMC), 124 only brain metastases and 14 both. In regard to phenotype, 43pts were [HR+, HER2-] (5 LMC), 68 were TN (13 LMC) and 51 were [HR+/-, HER2 +] (15 LMC). 152 pts had stages I-III (96.8% of all SNC relapses). There was no association between phenotypes and age at CNS relapse, ECOG PS, extracraneal metastases, control of primary tumor, number or volume of brain metastases. Significant association was found between phenotype and time from diagnosis to CNS relapse (≤8 months: 16.3% in TN, 7.3% in Her-2 and 0% for [HR+, HER2-], [P=0.017] ) and histological grade (grade III: 74.4% in TN, 55.% in Her-2 and 30% for [HR+, HER2-], [P=0.006]). Symptoms/signs frequently described in LMC patients were cephalea (72%), meningism (24%), nausea (24%), vomiting (20%), ataxia (20%), facial palsy (16%), somnolence (16%), paraparesia (12%), hiporeflexia (12%), apraxia (12%), arreflexia (12%), poor sphincter control (12%), hemiparesia (8%), seizures (8%), bradipsiquia (8%), neuropathic pain (4%). Fifty percent of TN pts with LMC had meningism. Post recurrence survival was shorter in TN patients (3.61mo vs 4.89mo to [HR+, HER2-] vs 5.95mo to [HR+/-, HER2 +; P=0.044] and in patients with meningism (1.38mo vs 5.26mo; P=0.02). Cox regression identify meningism as a risk factor for survival in patients relapsed with LMC (HR: 4.33; P=0.066). Conclusions: Meningism seems to be the only sign related to poor prognosis in patients relapsed with LMC.