Single institution validation of a modified graded prognostic assessment of patients with breast cancer brain metastases

Tai, Cheng-Hung; Wu, Cheng‐Chia; Hwang, M.; Saraf, Anurag; Grubb, Christopher S.; Jani, Ashish; Lapa, M.E.; Andrews, J.I.S.; Isaacson, Steven R.; Sonabend, Adam M.; Sheth, Sameer A.; McKhann, Guy M.; Sisti, Michael B.; Bruce, Jeffrey N.; Cheng, Simon K.; Connolly, Eileen; Wang, Tony Jc

doi:10.2217/cns-2017-0023

Cited by 10 publications

(6 citation statements)

References 32 publications

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“…An increasing body of evidence is now available to support clinical judgment in assessing patients' survival prognosis. 4,8,10,11,18,27 RPA was the most accurate score in identifying patients with different duration of life expectancy. 24 However, the study did not include the MB-GPA index.…”

Section: Discussionmentioning

confidence: 94%

“…An increasing body of evidence is now available to support clinical judgment in assessing patients’ survival prognosis . A good prognostic value in predicting OS was confirmed for all four prognostic classifications in our analysis, with SS‐BM and MB‐GPA indexes showing best discrimination regarding different calculated scores.…”

Section: Discussionmentioning

confidence: 99%

“…However, the study did not include the MB‐GPA index . Breast‐GPA was validated in several studies, but when compared to MB‐GPA, the latter performed better …”

Section: Discussionmentioning

confidence: 99%

“…24 Breast-GPA was validated in several studies, 4,11,23,28 but when compared to MB-GPA, the latter performed better. 4,11,27 Few data are available regarding prognostic models in patients with LM carcinomatosis who in general have a very poor prognosis and are rarely included in the prognostic score or nomogram development. 29 In our subset of seventy patients with LM, both SS-BM and Breast-GPA scores significantly predicted survival, but results have to be confirmed in future prospective studies.…”

Section: Discussionmentioning

confidence: 99%

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Breast cancer patients with brain metastases or leptomeningeal disease: 10‐year results of a national cohort with validation of prognostic indexes

et al. 2019

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Development of brain metastasis (BM) and leptomeningeal (LM) disease in breast cancer (BC) patients indicates poor prognosis and impairs patients’ quality of life. Prognostic survival scores for BM can help predict expected survival in order to choose the most appropriate treatment. The aim of our study was to analyze national data for BC patients treated with radiation therapy for BM/LM disease and validate the applicability of different survival prognostic scores. We retrospectively evaluated medical records of 423 BC patients with BM/LM disease receiving radiation therapy between April 2005 and December 2015. Patients were classified by BC Recursive Partitioning Analysis (B‐RPA), Breast Graded Prognostic Assessment (Breast‐GPA), Modified Breast Graded Prognostic Assessment (MB‐GPA), and Simple Survival score for patients with BM from BC (SS‐BM). Overall survival (OS) was calculated from the development of BM/LM disease to death or last follow‐up date. After a median follow‐up of 7.5 years, the median OS was 6.9 months (95% CI 5.5‐7.8, range 0‐146.4) and 1‐ and 2‐year survival rates were 35% and 17%, respectively. Survival analysis showed significant differences in median OS regarding biologic subtypes (P < 0.0001), as follows: 3.2 (95% Confidence Interval (CI) 2.5‐3.9), 3.9 (95% CI 2.3‐5.6), 7.1 (95% CI 4.3‐9.8), 12.1 (95% CI 8.3‐15.9), and 15.4 (95% CI 8.8‐22.1) months for primary triple‐negative BC (TNBC), Luminal B HER2‐negative, Luminal A, HER2‐enriched, and Luminal B HER2‐positive tumors, respectively. Good Karnofsky Performance Status (KPS), single metastasis, and absence of LM or extracranial disease all demonstrated better OS in univariate and multivariate analysis. All four employed prognostic indexes provided good prognostic value in predicting survival. SS‐BM and MB‐GPA showed the best discriminating ability (Concordance indexes C were 0.768 and 0.738, respectively). This study presents one of the largest single‐institution series validating prognostic scores for BC patients with BM/LM. SS‐BM and MB‐GPA proved to be useful tools in the clinical decision‐making process.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“…However, the study did not include the MB‐GPA index . Breast‐GPA was validated in several studies, but when compared to MB‐GPA, the latter performed better …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Breast cancer patients with brain metastases or leptomeningeal disease: 10‐year results of a national cohort with validation of prognostic indexes

et al. 2019

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“…So, infratentorial BM were associated with higher morbidity and complications rates in surgical series. [ 14 , 63 , 70 ] Different risk scores based on the patients’ age, KPS scale values, and BC subtype, as well as the patterns of intracranial and extracranial metastases were also confirmed as reliable prognostic markers for BCBM patients [ 17 , 60 , 62 , 63 , 66 ].…”

Section: Discussionmentioning

confidence: 97%

Radiographic markers of breast cancer brain metastases: relation to clinical characteristics and postoperative outcome

et al. 2021

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Objective Occurrence of brain metastases BM is associated with poor prognosis in patients with breast cancer (BC). Magnetic resonance imaging (MRI) is the standard of care in the diagnosis of BM and determines further treatment strategy. The aim of the present study was to evaluate the association between the radiographic markers of BCBM on MRI with other patients’ characteristics and overall survival (OS). Methods We included 88 female patients who underwent BCBM surgery in our institution from 2008 to 2019. Data on demographic, clinical, and histopathological characteristics of the patients and postoperative survival were collected from the electronic health records. Radiographic features of BM were assessed upon the preoperative MRI. Univariable and multivariable analyses were performed. Results The median OS was 17 months. Of all evaluated radiographic markers of BCBM, only the presence of necrosis was independently associated with OS (14.5 vs 22.5 months, p = 0.027). In turn, intra-tumoral necrosis was more often in individuals with shorter time interval between BC and BM diagnosis (< 3 years, p = 0.035) and preoperative leukocytosis (p = 0.022). Moreover, dural affection of BM was more common in individuals with positive human epidermal growth factor receptor 2 status (p = 0.015) and supratentorial BM location (p = 0.024). Conclusion Intra-tumoral necrosis demonstrated significant association with OS after BM surgery in patients with BC. The radiographic pattern of BM on the preoperative MRI depends on certain tumor and clinical characteristics of patients.

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Indications for Stereotactic Radiosurgery: Multiple Brain Metastases

Saraf

Wang

2020

Radiotherapy in Managing Brain Metastases

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Single institution validation of a modified graded prognostic assessment of patients with breast cancer brain metastases

Cited by 10 publications

References 32 publications

Breast cancer patients with brain metastases or leptomeningeal disease: 10‐year results of a national cohort with validation of prognostic indexes

Breast cancer patients with brain metastases or leptomeningeal disease: 10‐year results of a national cohort with validation of prognostic indexes

Radiographic markers of breast cancer brain metastases: relation to clinical characteristics and postoperative outcome

Indications for Stereotactic Radiosurgery: Multiple Brain Metastases

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