title: Prognostic factors for patients with brain metastasis from gynecological cancer: a significance of treatment-free interval of more than 6 months.
abstract: OBJECTIVE
  Treatment-free interval has been confirmed as a significant prognostic factor in recurrent gynecological cancers. However, treatment-free interval has not been evaluated in previous studies investigating brain metastasis from gynecological malignancies. The aim of the study was to establish a predictive model of survival period after brain metastasis from gynecological cancer.
  
  
  METHODS
  Of a total of 2848 patients with gynecological cancer, patients with brain metastasis were included in the study. Data at the time of brain metastasis diagnosis, which included primary origin, presence of extracranial metastasis, the Eastern Cooperative Oncology Group (ECOG) performance status, the number of brain metastases, brain-metastasis free-interval, treatment-free interval and treatment for brain metastasis were collected. Survival data were analyzed using Kaplan-Meier methods and Cox proportional hazards models.
  
  
  RESULTS
  Incidences of brain metastasis were 1.7% (47/2848). Median survival period after diagnosis of brain metastasis was 20 weeks (4-5 months). The 6-, 12- and 24-month survival rates after brain metastasis were 44.0%, 22.0% and 16.5%, respectively. Cox regression analysis showed that extracranial metastasis (hazard ratio [HR], 5.2; 95% confidence interval [CI]: 1.04-26.3), ECOG performance status of 3-4 (HR, 3.1; 95% CI: 1.20-7.91), treatment-free interval of <6 months (HR, 3.8; 95% CI: 1.09-13.1), and no anti-cancer treatment for brain metastasis (HR, 3.6; 95% CI: 1.34-9.41) were significantly and independently related to poor survival.
  
  
  CONCLUSIONS
  Treatment-free interval should be assessed in a future study to verify prognostic predictors of brain metastasis from gynecological cancer.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Sho
authors.initials: S
authors.lastname: Takeshita
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Yu
authors.initials: Y
authors.lastname: Furuta
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.affiliation: Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Katsushige
authors.initials: K
authors.lastname: Yamashiro
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
keywords: brain metastasis; gynecological cancer; ovarian cancer; prognosis; treatment-free interval