超越更新后的分级预后评估（乳腺癌 GPA）：从 1985 年至今乳腺癌脑转移的预后指数及治疗和生存趋势。
Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today.
机构信息
Minneapolis Radiation Oncology & University of Minnesota Gamma Knife Center, Minneapolis, Minnesota.
MD Anderson Cancer Center, Houston, Texas.
出版信息
Int J Radiat Oncol Biol Phys. 2020 Jun 1;107(2):334-343. doi: 10.1016/j.ijrobp.2020.01.051. Epub 2020 Feb 19.
PURPOSE
Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts.
METHODS AND MATERIALS
A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively.
RESULTS
Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01).
CONCLUSIONS
MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
目的
脑转移是乳腺癌的常见后遗症。基于特定于诊断的预后因素 (PF)，生存情况差异很大。我们之前根据队列 A（1985-2007 年，n=642）发布了一个用于乳腺癌伴脑转移患者（BCBM）的预后指数（分级预后评估 [GPA]），然后对其进行了更新，报告了队列 B（1993-2010 年，n=400）中肿瘤亚型的影响。本研究的目的是使用更大的当代队列（C）更新乳腺癌 GPA，并比较三个队列的治疗和生存情况。
方法和材料
创建了一个多机构（19 个）、多国家（3 个）的回顾性数据库，其中包含 2006 年 1 月 1 日至 2017 年 12 月 31 日期间诊断为新发脑转移的 2473 例乳腺癌患者（BCBM）的信息，并与之前的队列进行了比较。分析了 PF 和治疗与生存的关系。使用 Kaplan-Meier 生存估计和对数秩检验进行比较。对 PF 进行加权，更新了乳腺癌 GPA，使得 GPA 为 0 和 4.0 分别与最差和最好的预后相关。
结果
队列 A、B 和 C 的中位生存时间（MS）随着时间的推移而提高（分别从 11、14 到 16 个月，P<.01），尽管肿瘤亚型分布变得不那么有利。对生存有显著影响的 PF 是肿瘤亚型、卡诺夫斯基表现状态、年龄、BCBM 数量和颅外转移（均 P<.01）。GPA 为 0 至 1.0、1.5-2.0、2.5-3.0 和 3.5-4.0 的 MS 分别为 6、13、24 和 36 个月。在队列 B 和 C 之间，人表皮受体 2+亚型的比例从 31%下降到 18%（P<.01），该亚型的 MS 从 18 个月增加到 25 个月（P<.01）。
结论
MS 略有改善，但差异很大，取决于特定于诊断的 PF。已经确定了新的 PF，并将其纳入了更新的乳腺癌 GPA（可在 brainmetgpa.com 上获得免费在线计算器）。乳腺癌 GPA 有助于临床决策，并将有助于未来临床试验的分层。此外，这些数据表明，人表皮受体 2 靶向治疗改善了一些乳腺癌伴脑转移患者的临床结局。
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