Weykamp Fabian, El Shafie Rami A, König Laila, Seidensaal Katharina, Forster Tobias, Arians Nathalie, Regnery Sebastian, Hoegen Philipp, Deutsch Thomas M, Schneeweiss Andreas, Debus Jürgen, Hörner-Rieber Juliane
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
Front Oncol. 2020 Sep 2;10:1557. doi: 10.3389/fonc.2020.01557. eCollection 2020.
Several prognostic indexes for overall survival (OS) after radiotherapy of brain metastases in breast cancer patients exist but are mainly validated for whole-brain radiotherapy or not specifically for breast cancer patients. To date, no such index provides information beyond mere OS. We retrospectively analyzed 95 breast cancer patients treated with stereotactic radiosurgery for 203 brain metastases. The Kaplan-Meier method with log-rank test was used to assess OS, local control (LC), distant cranial control (DCC), and extracranial control (EC). Cox regression was applied to detect prognostic outcome factors. A point scoring system was designed to stratify patients based on outcome. Nine established prognostic indexes were analyzed using the concordance index (c-index). Two out of nine analyzed prognostic indexes for OS showed a significant c-index, the breast graded prognostic assessment (bGPA; 0.631; 95% CI, 0.514-0.748; = 0.037) and the modified bGPA (mod-bGPA; 0.662; 95% CI, 0.547-0.777; = 0.010). Significant results from multivariate analysis (Karnofsky Performance Score, Her2/neu receptor status, extracranial control) were used to generate a new point system: the breast cancer stereotactic radiotherapy score (bSRS), which discriminated three significantly different prognostic groups, for LC, DCC, EC, and OS, respectively. However, the c-index was only significant for OS (0.689; 95% CI, 0.577-0.802; = 0.003). The new bSRS score was superior to the bGPA and mod-bGPA scores for prognosis of OS. The bSRS is easy to use and the first tool, which might also provide outcome assessment beyond mere OS. Future studies need to validate these findings.
乳腺癌患者脑转移瘤放疗后的总生存期（OS）存在多种预后指标，但主要是针对全脑放疗进行验证，或者并非专门针对乳腺癌患者。迄今为止，尚无此类指标能提供超出单纯总生存期之外的信息。我们回顾性分析了95例接受立体定向放射外科治疗203个脑转移瘤的乳腺癌患者。采用Kaplan-Meier法和对数秩检验评估总生存期、局部控制（LC）、远处颅脑控制（DCC）和颅外控制（EC）。应用Cox回归检测预后结局因素。设计了一个评分系统，根据结局对患者进行分层。使用一致性指数（c指数）分析了9个既定的预后指标。分析的9个总生存期预后指标中有2个显示出显著的c指数，即乳腺分级预后评估（bGPA；0.631；95%CI，0.514 - 0.748；P = 0.037）和改良bGPA（mod-bGPA；0.662；95%CI，0.547 - 0.777；P = 0.）。多因素分析的显著结果（卡诺夫斯基功能状态评分、Her2/neu受体状态、颅外控制）用于生成一个新的评分系统：乳腺癌立体定向放疗评分（bSRS），该评分分别区分了三个在局部控制、远处颅脑控制、颅外控制和总生存期方面有显著差异的预后组。然而，c指数仅在总生存期方面显著（0.689；95%CI，0.577 - 0.802；P = 0.003）。新的bSRS评分在总生存期预后方面优于bGPA和mod-bGPA评分。bSRS易于使用，是首个可能还能提供超出单纯总生存期之外的结局评估的工具。未来的研究需要验证这些发现。
