title: Beyond breast specific-Graded Prognostic Assessment in patients with brain metastases from breast cancer: treatment impact on outcome.
abstract: Brain metastases are a serious relatively common complication of breast cancer. We evaluated prognostic factors for survival after diagnosis of brain metastases from breast cancer in a contemporary cohort of patients. Patients diagnosed with breast cancer brain metastases at our institution between 1999 and March 2016 were evaluated. Overall survival was defined as time from brain metastasis diagnosis to death or last follow-up. Patients were classified according to the Breast cancer-specific Graded Prognostic Assessment (BS-GPA), based on age, Karnofsky performance score and breast cancer phenotype. 181 patients were identified. Tumor phenotype distribution was as follows: triple negative (TN, 18.8%), hormone receptor (HR)-HER2+ (16.6%), HR+HER2+ (23.2%) and HR+HER2- (30.9%), not available (10.5%). Median overall survival from brain metastasis diagnosis was 7.7 mos (95% CI 5.4-10.0 mos). Although TN patients experienced the worse outcome, no significant difference was observed across tumor phenotypes (median 5.1, 7.7, 11.0 and 8.6 months in TN, HR-HER2+, HR+HER2+, HR+HER2-, p = 0.081). The BS-GPA index was significantly associated with overall survival (median 18.8, 8.8, 6.2 and 3.6 months, respectively, for BS-GPA categories 3.5-4, 2.5-3, 1.5-2 and 0-1, p = 0.014). Increased number of local treatments for brain metastasis (radiotherapy or neurosurgery) or the administration of systemic therapy after brain metastasis diagnosis were also significant predictors of better overall survival (p < 0.001) and, when evaluated in multivariate analysis with BS-GPA, both added independent prognostication beyond BS-GPA. Patient-related features, tumor phenotype and multimodal treatments all independently contribute to modulate prognosis of patients diagnosed with breast cancer brain metastases.
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Griguolo
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy. mariavittoria.dieci@unipd.it.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. mariavittoria.dieci@unipd.it.
authors.forename: Maria Vittoria
authors.identifier: 0000-0002-3967-9861
authors.initials: MV
authors.lastname: Dieci
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Giarratano
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Giorgi
authors.affiliation: Department of Pathology, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Orvieto
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ghiotto
authors.affiliation: Radiation Therapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Berti
authors.affiliation: Department of Neurosurgery, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Falci
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Mioranza
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Tasca
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Milite
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Miglietta
authors.affiliation: Department of Neurosurgery, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Conte
authors.affiliation: Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Guarneri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain metastases; Breast cancer; Graded Prognostic Assessment; Prognosis; Treatment