Prediction of outcomes for patients with brain parenchymal metastases from breast cancer (BC): a new BC-specific prognostic model and a nomogram.
The purpose of this study is to validate the recently published Breast-Graded Prognostic Assessment (GPA) and propose a new prognostic model and nomogram for patients with brain parenchymal metastases (BM) from breast cancer (BC). We retrospectively investigated 171 consecutive patients who received a diagnosis of BM from BC during 2000-2008. We appraised the recently proposed Sperduto's BC-specific GPA in training cohort through Kaplan-Meier survival curve using log-rank test and area under the curve for the BC-GPA predicting overall survival at 1 year and developed a new nomogram to predict outcomes using multivariate Cox-regression analysis. By putting the Sperduto's Breast-GPA together with our nomogram, we developed a new prognostic model. We validated our new prognostic model with an independent external patient cohort from 2 institutes for the same period. On the basis of our Cox-regression analysis, therapeutic effect of trastuzumab and status of extracranial systemic disease control were incorporated into our new prognostic model in addition to Karnofsky performance status, age, and hormonal status. Our new prognostic model showed significant discrimination in median survival time, with 3.7 months for class I (n = 15), 7.8 months for class II (n = 82), 10.7 months for class III (n = 42), and 19.2 months for class IV (n = 32; P < .0001). The new prognostic model accurately predicted survival among patients with BC from BM in an external validation cohort (P < .0001). We propose a new prognostic model and a nomogram reflecting the different biological features of BC, including treatment effect and status of extracranial disease control, which was excellently validated in an independent external cohort.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea.
Hee Kyung
HK
Ahn
Soohyeon
S
Lee
Yeon Hee
YH
Park
Joo Hyuk
JH
Sohn
Jae-Cheol
JC
Jo
Jin-Hee
JH
Ahn
Kyung Hae
KH
Jung
Silvia
S
Park
Eun Yoon
EY
Cho
Jung Il
JI
Lee
Won
W
Park
Doo Ho
DH
Choi
Seung Jae
SJ
Huh
Jin Seok
JS
Ahn
Sung-Bae
SB
Kim
Young-Hyuck
YH
Im
D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D016896:Treatment Outcome