title: Validity of three recently proposed prognostic grading indexes for breast cancer patients with radiosurgically treated brain metastases.
abstract: OBJECTIVE
  We tested the validity of 3 recently proposed prognostic indexes for breast cancer patients with brain metastases (METs) treated radiosurgically. The 3 indexes are Diagnosis-Specific Graded Prognostic Assessment (DS-GPA), New Breast Cancer (NBC)-Recursive Partitioning Analysis (RPA), and our index, sub-classification of RPA class II patients into 3 sub-classes (RPA class II-a, II-b and II-c) based on Karnofsky performance status, tumor number, original tumor status, and non-brain METs.
  
  
  METHODS
  This was an institutional review board-approved, retrospective cohort study using our database of 269 consecutive female breast cancer patients (mean age, 55 years; range, 26-86 years) who underwent Gamma Knife radiosurgery (GKRS) alone, without whole-brain radiation therapy, for brain METs during the 15-year period between 1996 and 2011. The Kaplan-Meier method was used to estimate the absolute risk of each event.
  
  
  RESULTS
  Kaplan-Meier plots of our patient series showed statistically significant survival differences among patients stratified into 3, 4, or 5 groups based on the 3 systems (P<.001). However, the mean survival time (MST) differences between some pairs of groups failed to reach statistical significance with all 3 systems. Thus, we attempted to regrade our 269 breast cancer patients into 3 groups by modifying our aforementioned index along with the original RPA class I and III, (ie, RPA I+II-a, II-b, and II-c+III). There were statistically significant MST differences among these 3 groups without overlap of 95% confidence intervals (CIs) between any 2 pairs of groups: 18.4 (95% CI = 14.0-29.5) months in I+II-a, 9.2 in II-b (95% CI = 6.8-12.9, P<.001 vs I+II-a) and 5.0 in II-c+III (95% CI = 4.2-6.8, P<.001 vs II-b).
  
  
  CONCLUSIONS
  As none of the new grading systems, DS-GPS, BC-RPA and our system, was applicable to our set of radiosurgically treated patients for comparing survivals after GKRS, we slightly modified our system for breast cancer patients.
authors.affiliation: Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan. BCD06275@nifty.com
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Kawabe
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Higuchi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.forename: Bierta E
authors.initials: BE
authors.lastname: Barfod
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kasuya
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Urakawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000145:classification / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology; D002423:Cause of Death; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading / Q000379:methods*; D018579:Patient Selection; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D015203:Reproducibility of Results; D012189:Retrospective Studies