Leptomeningeal metastasis in triple-negative breast cancer: a retrospective study

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BACKGROUND: Leptomeningeal metastasis (LM) in triple-negative breast cancer (TNBC) poses significant clinical challenges due to its rapid progression and dismal prognosis. The low incidence (2-5%) of LM in patients with breast cancer underscores the urgent need for comprehensive research efforts in this critical domain. METHODS: A retrospective analysis of 45 TNBC patients with LM was conducted to assess their clinical profiles, treatments, and survival outcomes, aiming to improve prognosis. RESULTS: LM was diagnosed in 41 patients through cerebrospinal fluid (CSF) cytology and in 24 patients through magnetic resonance imaging (MRI), with sensitivities of 85.4% and 57.1%, respectively. The median overall survival (OS) for all patients was 4.4 (95% confidence interval [CI], 2.1-6.7) months. Among 45 patients, 40% (18/45) received systemic treatment, 44.4% (20/45) received local treatment, and notably, 24.4% (11/45) received both. Factors significantly associated with overall survival included Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 3 (hazard ratio [HR], 3.51; p = 0.024), receipt of systemic chemotherapy (HR, 0.07; p < 0.001), and administration of intrathecal chemotherapy (IC) (HR, 0.07; p = 0.010). Furthermore, specific combinations of systemic and local treatments demonstrated favorable prognosis, including concurrent systemic chemotherapy with IC (p < 0.01) and sequential systemic chemotherapy with radiotherapy (p < 0.001). CONCLUSION: Our investigation revealed a dismal prognosis for LM in TNBC patients. Optimal diagnostic accuracy is achieved through integrating CSF analysis and neuroimaging. Post-diagnosis, combining local and systemic treatments is recommended for patients with a favorable performance status.

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