Clinicopathologic characteristics and survival of patients with gynecologic malignancies metastatic to the brain. Gynecol Oncol 2016 Jul;142(1):76-82
Date
04/28/2016Pubmed ID
27117923Pubmed Central ID
PMC5096388DOI
10.1016/j.ygyno.2016.04.030Scopus ID
2-s2.0-84975127258 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
OBJECTIVE: No standardized treatment strategies exist for patients with gynecologic malignancies complicated by brain metastases. Identification of poor outcome characteristics, long-term survival indicators, and molecular markers could help individualize and optimize treatment.
METHODS: This retrospective cohort study included 100 gynecologic cancer patients with brain metastases treated at our institution between January 1990 and June 2009. Primary outcome was overall survival (OS) from time of diagnosis of brain metastases. We used univariate and multivariate analyses to evaluate associations between OS and clinical factors. We used immunohistochemistry to examine expression of five molecular markers in primary tumors and brain metastases in a subset of patients and matched controls. Statistical tests included the Student's paired t-test (for marker expression) and Kaplan-Meier test (for correlations).
RESULTS: On univariate analysis, primary ovarian disease, CA-125<81units/mL at brain metastases diagnosis, and isolated versus multi-focal metastases were all associated with longer survival. Isolated brain metastasis remained the only significant predictor on multivariate analysis (HR 2.66; CI 1.19-5.93; p=0.017). Expression of vascular endothelial growth factor A (VEGF-A) was higher in metastatic brain samples than in primary tumors of controls (p<0.0001). None of the molecular markers were significantly associated with survival.
CONCLUSIONS: Multi-modality therapy may lead to improved clinical outcomes, and VEGF therapy should be investigated in treatment of brain metastases.
Author List
Divine LM, Kizer NT, Hagemann AR, Pittman ME, Chen L, Powell MA, Mutch DG, Rader JS, Thaker PHAuthor
Janet Sue Rader MD Chair, Professor in the Obstetrics and Gynecology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Biomarkers, Tumor
Brain Neoplasms
Cohort Studies
Female
Genital Neoplasms, Female
Humans
Immunohistochemistry
Middle Aged
Neoplasm Staging
Retrospective Studies
Vascular Endothelial Growth Factor A
