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

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.

A retrospective analysis of 45 TNBC patients with LM was conducted to assess their clinical profiles, treatments, and survival outcomes, aiming to improve prognosis.

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).

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.