Clinicopathological Features, Treatment Modalities, and Prognostic Factors of Leptomeningeal Carcinomatosis in Patients with Breast Cancer: A Single-Center Retrospective Analysis

Öz

Aim: Leptomeningeal metastasis (LM) from breast cancer carries a poor prognosis, and most published cohorts originate from high-volume referral centers. We aimed to identify factors associated with overall survival (OS) after an LM diagnosis in routine practice and to describe diagnostic and treatment patterns. Methods: We retrospectively reviewed consecutive women treated for breast cancer–related LM at a single tertiary center between February 2018 and December 2023. LM was classified according to the European Association of Neuro-Oncology–European Society for Medical Oncology criteria. OS was measured from the LM diagnosis and estimated by the Kaplan–Meier method. Candidate variables were examined by Cox regression. Landmark analyses at 4 weeks were used to limit immortal time bias. Results: Thirty-eight women were included; median age at LM diagnosis was 57.0 years. The diagnosis was cytologically or histologically confirmed (type I) in 12 patients (31.6%). After the LM diagnosis, 32 patients (84.2%) received systemic therapy, 22 (57.9%) radiotherapy, and 5 (13.2%) intrathecal methotrexate. Thirty-five patients (92.1%) had died. Median OS was 2.8 months (95% confidence interval [CI], 1.4–8.8); 6- and 24-month survival were 39.5% and 12.3%, respectively. No variable reached P < 0.10 in univariable analysis; radiotherapy had the lowest P value (hazard ratio 0.57; 95% CI, 0.28–1.15; P = 0.11). An exploratory multivariable model, specified before fitting, showed no independent association. Conclusions: Median survival was 2.8 months, and no independent prognostic factor was identified. The low rate of cytological confirmation limits comparison with referral-center series.

Anahtar Kelimeler

• Breast Neoplasms
• Meningeal Carcinomatosis
• Methotrexate
• Prognosis
• Survival Analysis

Etik Beyan

The study was approved by the Çukurova University Faculty of Medicine Research Ethics Committee (meeting no. 166, decision no. 76; 8 May 2026) and was conducted in accordance with the Declaration of Helsinki. Given the retrospective design and the use of anonymized records, the committee waived the requirement for written informed consent.

Meme Kanseri Tanılı Hastalarda Leptomeningeal Karsinomatozun Klinikopatolojik Özellikleri, Tedavi Modaliteleri ve Prognostik Faktörleri: Tek Merkezli Retrospektif Analiz

Öz

Amaç: Meme kanserine bağlı leptomeningeal metastaz (LM) kötü prognozludur ve yayımlanmış kohortların çoğu yüksek hacimli sevk merkezlerinden gelmektedir. Bu çalışmanın amacı, rutin klinik uygulamada LM tanısı sonrası genel sağkalım (GSK) ile ilişkili faktörleri belirlemek ve tanısal özellikler ile tedavi örüntülerini tanımlamaktı. Yöntem: Çalışma tek merkezli retrospektif kohort olarak tasarlandı. Şubat 2018 ile Aralık 2023 arasında tek bir üçüncü basamak merkezde meme kanserine bağlı LM nedeniyle izlenen ardışık kadın hastalar dahil edildi. LM, Avrupa Nöro-Onkoloji Birliği-Avrupa Tıbbi Onkoloji Derneği ölçütlerine göre sınıflandırıldı. GSK, LM tanısından itibaren hesaplandı ve Kaplan-Meier yöntemiyle tahmin edildi. Aday değişkenler Cox regresyonu ile incelendi. Ölümsüz zaman yanlılığını sınırlamak amacıyla 4. haftada landmark analizleri yapıldı. Bulgular: Otuz sekiz kadın hasta dahil edildi; LM tanısındaki ortanca yaş 57.0 yıl idi. Tanı 12 hastada (%31.6) sitolojik veya histolojik olarak doğrulandı (tip I). LM tanısı sonrasında 32 hasta (%84.2) sistemik tedavi, 22 hasta (%57.9) radyoterapi ve 5 hasta (%13.2) intratekal metotreksat aldı. Otuz beş hasta (%92.1) hayatını kaybetti. Ortanca GSK 2.8 ay idi (%95 güven aralığı [GA]: 1.4-8.8); 6 ve 24 aylık sağkalım sırasıyla %39.5 ve %12.3 idi. Tek değişkenli analizde hiçbir değişken P<0.10 düzeyine ulaşmadı; en düşük P değeri radyoterapiye aitti (tehlike oranı 0.57; %95 GA: 0.28-1.15; P=0.11). Önceden tanımlanmış keşfedici çok değişkenli modelde bağımsız ilişki saptanmadı. Sonuç: Ortanca sağkalım 2.8 ay bulundu ve bağımsız prognostik faktör saptanmadı. Sitolojik doğrulama oranının düşüklüğü, sevk merkezi serileriyle karşılaştırmayı kısıtlamaktadır.

Anahtar Kelimeler

• Meme Neoplazileri
• Meningeal Karsinomatoz
• Metotreksat
• Prognoz
• Sağkalım Analizi

Etik Beyan

Çalışma, Çukurova Üniversitesi Tıp Fakültesi Araştırma Etik Kurulu tarafından onaylanmıştır (toplantı sayısı 166, karar no 76; 8 Mayıs 2026) ve Helsinki Bildirgesi'ne uygun olarak yürütülmüştür. Çalışmanın geriye dönük tasarımı ve anonimleştirilmiş kayıtların kullanılması nedeniyle kurul, yazılı bilgilendirilmiş onam alınması koşulundan muafiyet vermiştir.

Kaynakça

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