Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, 35128, Padova, Italy.
Department of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France.
Breast. 2018 Feb;37:36-41. doi: 10.1016/j.breast.2017.10.006. Epub 2017 Oct 23.
Several prognostic scores have been developed to estimate survival of breast cancer (BC) patients with brain metastases (BM). Modified Breast Graded Prognostic Assessment (GPA), based on a single-institution cohort of 1552 patients, has been proposed as refinement of Breast-GPA. In addition to age, tumour subtype and KPS, Modified Breast-GPA comprises number of BM. This study was designed to validate Modified Breast-GPA.
Clinical data of 668 BC patients diagnosed with BM at four institutions between 1996 and 2016 were reviewed. Patients were classified by Breast-GPA and Modified Breast-GPA. Overall survival (OS) was calculated from time of BM diagnosis to death or last follow-up. Cox proportional models were used to calculate hazard-ratios and their 95% CI. The performances of Breast-GPA and Modified Breast-GPA were compared using Harrell's concordance index.
Median age at BM diagnosis was 56 years (range 24-85). At last follow-up, 632 patients (94.6%) had died. Median OS was 8.1 months (95% CI 6.9-9.4). The number of BM (1-3 vs. >3) was significantly associated with OS in univariate analysis (p < 0.001) and having >3 BM was identified as a negative prognostic factor in multivariate analysis. Both Breast-GPA and Modified Breast-GPA accurately predicted OS (p < 0.001 for both scores). Performance of Modified Breast-GPA was better: concordance indices were 0.6390 (95% CI, 0.6381 to 0.6399) and 0.6647 (95% CI, 0.6639 to 0.6655) for Breast-GPA and Modified Breast-GPA, respectively (p < 0.001).
This work provides the first external independent validation of Modified Breast-GPA and confirms its better performance as compared to Breast-GPA.
已经开发了几种预后评分来评估乳腺癌（BC）伴脑转移（BM）患者的生存情况。改良乳腺分级预后评估（GPA）是基于 1552 例患者的单中心队列提出的，是乳腺-GPA 的改进。除年龄、肿瘤亚型和 KPS 外，改良乳腺-GPA 还包括 BM 的数量。本研究旨在验证改良乳腺-GPA。
回顾了 1996 年至 2016 年在四个机构诊断为 BM 的 668 例 BC 患者的临床数据。患者根据乳腺-GPA 和改良乳腺-GPA 进行分类。从 BM 诊断到死亡或最后一次随访的总生存期（OS）进行计算。使用 Cox 比例模型计算风险比及其 95%CI。使用 Harrell 一致性指数比较乳腺-GPA 和改良乳腺-GPA 的性能。
BM 诊断时的中位年龄为 56 岁（范围 24-85）。最后一次随访时，632 例（94.6%）患者死亡。中位 OS 为 8.1 个月（95%CI 6.9-9.4）。在单因素分析中，BM 的数量（1-3 个 vs. >3 个）与 OS 显著相关（p<0.001），并且存在 >3 个 BM 被确定为多因素分析中的负预后因素。乳腺-GPA 和改良乳腺-GPA 均能准确预测 OS（p<0.001）。改良乳腺-GPA 的性能更好：乳腺-GPA 和改良乳腺-GPA 的一致性指数分别为 0.6390（95%CI，0.6381 至 0.6399）和 0.6647（95%CI，0.6639 至 0.6655）（p<0.001）。
本研究首次对改良乳腺-GPA 进行了外部独立验证，并证实其性能优于乳腺-GPA。
