title: Brain metastases from breast cancer: proposition of new prognostic score including molecular subtypes and treatment.
abstract: To develop a specific prognostic score for patients with brain metastases (BM) from breast cancer (BC), including the BC molecular subtype and treatment parameters, we analyzed the outcome of 130 patients with BM from BC who received whole-brain radiotherapy. We identified hierarchical risk groups for estimated survival by using recursive partitioning analysis (RPA). Seven prognostic factors, namely performance status, age, trastuzumab-based therapy for HER-2-overexpressing tumors, a triple-negative phenotype, Scarff-Bloom-Richardson grade, the serum LDH level and the lymphocyte count at BM diagnosis, were incorporated in the RPA. The final RPA nodes were grouped according to the survival time. The RPA tree showed that survival was best (median 19.5 months) among patients with HER2-overexpressing tumors who received trastuzumab-based therapy. The worst survival (median 3.5 months) was observed among patients who did not receive trastuzumab and who had lymphopenia at BM diagnosis, or KPS <70 and age over 50 years, or KPS ≥70 and a triple-negative tumor (HR- & HER-2-). The other patients had a median survival of 12.5 months (P < 0.001). This 3-class specific prognostic score successfully predicted the outcomes of a heterogeneous group of patients with brain metastases from BC.
authors: Department of Radiation Oncology, Institut Curie Hôpital René Huguenin, 35 rue Dailly, 92210 Saint Cloud, France. romuald.lescodan@curie.net
authors: Romuald
authors: R
authors: Le Scodan
authors: Christophe
authors: C
authors: Massard
authors: Ludivine
authors: L
authors: Jouanneau
authors: Florence
authors: F
authors: Coussy
authors: Maya
authors: M
authors: Gutierrez
authors: Youlia
authors: Y
authors: Kirova
authors: Florence
authors: F
authors: Lerebours
authors: Alain
authors: A
authors: Labib
authors: Emmanuelle
authors: E
authors: Mouret-Fourme
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis*; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003663:Decision Trees; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007770:L-Lactate Dehydrogenase / Q000097:blood; D018655:Lymphocyte Count; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis / Q000378:metabolism; D016019:Survival Analysis; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human