title: Assessment of prognostic scores in brain metastases from breast cancer.
abstract: BACKGROUND
  Breast cancer (BC) is the second most common cause of brain metastases (BM). Optimal management of BM from BC is still debated. In an attempt to provide appropriate treatment and to assist with optimal patient selection, several specific prognostic classifications for BM from BC have been established. We evaluated the prognostic value and validity of the 6 proposed scoring systems in an independent population of BC patients with BM.
  
  
  METHODS
  We retrospectively reviewed all consecutive BC patients referred to our institution for newly diagnosed BM between October 1995 and July 2011 (n = 149). Each of the 6 scores proposed for BM from BC (Sperduto, Niwinska, Park, Nieder, Le Scodan, and Claude) was applied to this population. The discriminative ability of each score was assessed using the Brier score and the C-index. Individual prognostic values of clinical and histological factors were analyzed using uni- and multivariate analyses.
  
  
  RESULTS
  Median overall survival was 15.1 months (95% CI,11.5-18.7). Sperduto-GPA (P < .001), Nieder (P < .001), Park (P < .001), Claude (P < .001), Niwinska (P < .001), and Le Scodan (P = .034) scores all showed significant prognostic value. The Nieder score showed the best discriminative ability (C-index, 0.672; Brier score error reduction, 16.1%).
  
  
  CONCLUSIONS
  The majority of prognostic scores were relevant for patients with BM from BC in our independent population, and the Nieder score seems to present the best predictive value but showed a relatively low positive predictive value. Thus, these results remain insufficient and challenge the routine use of these scoring systems.
authors: APHM, Timone Hospital, Departement of Neuro-Oncology, Marseille, France (E.T.); L'institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France (E.T., A.G.); APHM, Timone Hospital, Department of Neurosurgery, Marseille, France (P.M.); L'institut Paoli-Calmettes, Department of Biostatistics, Marseille, France (B.E.); UMR911, CRO2, Aix-Marseille Université, Marseille, France (P.M.); L'institut Paoli-Calmettes, Department of Anatomic Pathology, Marseille, France (E.C.-J.); L'institut Paoli-Calmettes, Department of Radiotherapy, Marseille, France (A.T.).
authors: Emeline
authors: E
authors: Tabouret
authors: Philippe
authors: P
authors: Metellus
authors: Anthony
authors: A
authors: Gonçalves
authors: Benjamin
authors: B
authors: Esterni
authors: Emmanuelle
authors: E
authors: Charaffe-Jauffret
authors: Patrice
authors: P
authors: Viens
authors: Agnés
authors: A
authors: Tallet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011379:Prognosis
keywords: brain metastases; breast cancer; prognostic scores