Freeman Mark, Ennis Marguerite, Jerzak Katarzyna J
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Independent Researcher, Markham ON, Canada.
Front Oncol. 2022 Jul 27;12:867462. doi: 10.3389/fonc.2022.867462. eCollection 2022.
To examine the association between Karnofsky Performance Status ("KPS") and brain-specific progression-free survival ("bsPFS") among patients with breast cancer brain metastases ("BCBrM").
Using a previously compiled retrospective cohort of 683 patients who were treated for BCBrM with surgery and/or radiotherapy at the Sunnybrook Odette Cancer Centre from 2008-2018, electronic records were reviewed to impute KPS scores at the time of BCBrM diagnosis. Patients were then grouped into KPS ≤60 and KPS >60 cohorts. The dataset was analyzed to identify variables that were prognostic for bsPFS and/or overall survival ("OS") using univariable and multivariable Cox proportional hazards models.
The mean age of patients was 57 (range 24-93). Most patients (=622, 91%) had extracranial metastatic disease and 174 (25%) had leptomeningeal disease. 247 patients (36%) had hormone receptor ("HR")-positive/human endothelial growth factor receptor 2 ("HER2")-negative tumours, 189 (28%) had HER2-positive disease, and 153 (22%) had triple-negative breast cancer. Of the 331 patients (48%) who could be assigned a KPS cohort, 102 (31%) had KPS ≤60. Most patients were treated with whole brain radiotherapy (=498, 73%) and/or stereotactic radiosurgery ("SRS") (=128, 19%). Median bsPFS was 9 months (95% CI 8-10 months) and median OS was not reached. In univariable analyses, KPS ≤60, presence of leptomeningeal disease, neurological symptoms, ≥2 brain metastases, and not undergoing SRS were factors associated with shorter bsPFS. In a multivariable analysis, KPS ≤60 was the only statistically significant determinant of bsPFS (HR 1.86, 95% CI 1.20-2.88). Although survival data was limited, KPS ≤60 was associated with shorter OS in both univariable (HR 3.12, 95% CI 1.85-5.26) and multivariable (HR 2.95, 95% CI 1.55-5.58) analyses.
Patients with BCBrM who have a KPS ≤60 have significantly shorter bsPFS and OS than those with KPS >60. KPS should be documented routinely at the time of diagnosis of brain metastases to improve prognostication.
研究乳腺癌脑转移（BCBrM）患者的卡氏功能状态评分（KPS）与脑特异性无进展生存期（bsPFS）之间的关联。
利用此前汇编的回顾性队列，纳入2008年至2018年在桑尼布鲁克奥德特癌症中心接受手术和/或放疗的683例BCBrM患者，查阅电子记录以推算BCBrM诊断时的KPS评分。然后将患者分为KPS≤60组和KPS>60组。使用单变量和多变量Cox比例风险模型分析数据集，以确定对bsPFS和/或总生存期（OS）具有预后意义的变量。
患者的平均年龄为57岁（范围24 - 93岁）。大多数患者（=622例，91%）有颅外转移疾病，174例（25%）有软脑膜疾病。247例患者（36%）患有激素受体（HR）阳性/人表皮生长因子受体2（HER2）阴性肿瘤，189例（28%）患有HER2阳性疾病，153例（22%）患有三阴性乳腺癌。在331例（48%）可归入KPS队列的患者中，102例（31%）的KPS≤60。大多数患者接受了全脑放疗（=498例，73%）和/或立体定向放射外科治疗（SRS）（=128例，19%）。中位bsPFS为9个月（95%CI 8 - 10个月），中位OS未达到。在单变量分析中，KPS≤60、存在软脑膜疾病、神经系统症状、≥2个脑转移灶以及未接受SRS是与较短bsPFS相关的因素。在多变量分析中，KPS≤60是bsPFS唯一具有统计学意义的决定因素（风险比[HR] 1.86，95%CI 1.20 - 2.88）。尽管生存数据有限，但在单变量（HR 3.12，95%CI 1.85 - 5.26）和多变量（HR 2.95，95%CI 1.55 - 5.58）分析中，KPS≤60均与较短的OS相关。
KPS≤60的BCBrM患者的bsPFS和OS明显短于KPS>60的患者。在脑转移诊断时应常规记录KPS，以改善预后评估。
