P14.08 Prognostic factors for the time from primary diagnosis to development of brain metastases in patients with breast cancer in Indonesia

Abstract

BACKGROUND: Brain metastasis from the breast cancer (BMBC) is the biggest challenge for neuro-oncologist since limited of availabilities on ­management and treatment for breast cancer (BC) patients. The problem is whether the identification of prognostic factors and the construction of prognostic model can help to screen and clinical management for BMBC patient? Goal and Objectives: The goal of this research to improve survival of BC patient by identifying prognostic factors for time of development of BMBC in Indonesian women. The objectives of this study: a) to describe epidemiology, management and prognostic factors of BMBC; b) identification main prognostic for BMBC and construct prognostic models for improving effectiveness and efficiencies of clinical management. Study Design: is a prospective cohort study. SETTINGS: This study was conducted on BC patients admitted to Dharmais National Cancer Hospital, Jakarta, Indonesia. Samples: followed-up prospectively for 516 BC without BMBC ages 25-75 who were attending hospital from January 1, 2013 to December 31, 2013. The cut of date of follow-up was July 31, 2015. We recorded event of BMBC, death, or lost to follow-up. Prognostic Factors: In addition to tumor subtype, the study collected data on surgery, chemotherapy, hormonal therapy and radiation to primary tumor and other risk factors, such as tumor subtype, metastases to extra cranial, age, stadium and tumor grade. Study Outcomes: The dependent variable of this study is the time since diagnosed BC until BMBC event. Risk factors identification used Cox’s regression to obtain relative risk (RR) estimates. Results: This is a first report on cumulative incidence of BMBC among BC patients using prospective design in Indonesia where the incidence of BMBC is reported as 15-20%. According to epidemiological profiles, BMBC are commonly found among younger women (age below 40 years), high school graduate or higher, and the hospital payment using insurance. A tumor subtype of Luminal A has higher percentage (48%) where HER2 subtype is lowest (11.7%) in Indonesia. This study found risks of having BMBC as follows: age at the time of BC diagnosed, tumor subtype (tests ER, PR and HER2 receptor), grade, stadium and metastases extracranial (lung, liver, bone). The best prognostic model (R(2) >15%) for the time to the development of BMBC using those factors has RR 2.6 to 8.8 which are statistically significant. CONCLUSION AND RECOMMENDATION: Breast cancer patient can be screened using prognostic factors at the earlier stage of care. We recommend to screen and manage BMBC patient by considering age of women, tumor subtype (tests ER, PR and HER2 receptor), grade, stadium and metastases extracranial (lung, liver, bone).