title: Predicting survival in women with breast cancer and brain metastasis: a nomogram outperforms current survival prediction models.
abstract: BACKGROUND
  Brain metastases (BMs) are a common occurrence in patients with breast cancer, and accurately predicting survival in these patients is critical to appropriate management. A survival nomogram for breast cancer patients with BM was constructed, and its performance is compared to current predictive models of survival.
  
  
  METHODS
  A Cox proportional hazards regression with a nomogram representation was used to model survival in a population of 261 women with breast cancer and BMs treated from 1999 to 2008. The model was validated internally by 10-fold cross-validation and bootstrapping, and concordance (c) indices were calculated. The predictive performance of the nomogram described here is compared to current prognostic models, including recursive partitioning analysis, graded prognostic assessment, and diagnosis-specific graded prognostic assessment.
  
  
  RESULTS
  The c-index for the model described here was 0.67. It outperformed recursive partitioning analysis, graded prognostic assessment, and diagnosis-specific graded prognostic assessment, based on c-index comparisons.
  
  
  CONCLUSIONS
  The nomogram described here outperformed current strategies for survival prediction in breast cancer patients with BMs. Two additional advantages of this nomogram are its ability to predict individualized, 1-, 3-, and 5-year survival for novel patients and its straightforward representations of the relative effects of each of 9 covariates on neurologic survival. This represents a potentially valuable alternative to current models of survival prediction in this patient population.
authors.affiliation: Cancer Research UK Cambridge Research Institute and Department of Applied Mathematics and Theoretical Physics, Cambridge University, United Kingdom. Nicholas.Marko@cancer.org.uk
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Marko
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.forename: Tianming
authors.initials: T
authors.lastname: Gao
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary*; D001943:Breast Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008875:Middle Aged; D015233:Models, Statistical; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome