Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea.
Neuro Oncol. 2012 Aug;14(8):1105-13. doi: 10.1093/neuonc/nos137. Epub 2012 Jun 11.
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.
本研究旨在验证最近发表的乳腺分级预后评估（GPA），并为乳腺癌（BC）脑实质转移（BM）患者提出新的预后模型和诺模图。我们回顾性研究了 2000 年至 2008 年间连续 171 例经诊断为 BM 的患者。我们通过 Kaplan-Meier 生存曲线和 log-rank 检验评估了最近提出的 Sperduto 的 BC 特异性 GPA 在训练队列中的预测价值，使用曲线下面积（AUC）来预测 BC-GPA 对 1 年总生存的预测，并用多变量 Cox 回归分析建立了一个新的诺模图来预测结局。通过将 Sperduto 的乳腺 GPA 与我们的诺模图相结合，我们开发了一种新的预后模型。我们使用同期来自 2 个机构的独立外部患者队列对我们的新预后模型进行了验证。基于我们的 Cox 回归分析，除了卡氏功能状态（KPS）、年龄和激素状态外，曲妥珠单抗的治疗效果和颅外全身疾病控制状况也被纳入到我们的新预后模型中。我们的新预后模型在中位生存时间上具有显著的区分度，I 级（n = 15）为 3.7 个月，II 级（n = 82）为 7.8 个月，III 级（n = 42）为 10.7 个月，IV 级（n = 32）为 19.2 个月（P <.0001）。新的预后模型在外部验证队列中准确地预测了 BM 患者的生存情况（P <.0001）。我们提出了一个新的预后模型和一个诺模图，反映了 BC 的不同生物学特征，包括治疗效果和颅外疾病控制状况，在一个独立的外部队列中得到了很好的验证。
