Department of Medical Oncology, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Medical Records, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
BMC Cancer. 2024 Oct 10;24(1):1262. doi: 10.1186/s12885-024-12983-3.
Breast cancer brain metastasis (BCBM) is associated with poor survival outcomes and reduced quality of life. The Graded Prognostic Assessment (GPA) score model serves as a well-established tool for predicting the prognosis of BCBM. Notably, the presence of extracranial metastasis (ECM) is considered as a significant prognostic factor in the breast GPA model. This study aims to further refine other features of ECM to enhance the prognostic prediction for BCBM.
This study included all inpatients diagnosed with BCBM at the Cancer Hospital, Chinese Academy of Medical Sciences, from January 2010 to July 2021. Baseline characteristics of patients were compared based on features of ECM, including the presence, number, location, and control status of metastases. Overall survival (OS) were compared using the Kaplan-Meier method with log-rank tests. Cox regression analyses were conducted to identify significant prognostic factors. The aforementioned ECM features were incorporated into the original Breast-GPA model to enhance its prognostic accuracy. The concordance index (C-index) and restricted mean survival time (RMST) were utilized to evaluate and compare the predictive accuracy of the updated and original survival models.
284 patients with BCBM were included in the study. Kaplan-Meier survival curves suggested that patients without ECM when diagnosed with BCBM showed better survival (p = 0.007). In the subgroups with ECM, more than 3 organs involved, both bone and visceral metastasis and progressive ECM portended dismal OS (p = 0.003, 0.001 and <0.001). Multivariate analysis demonstrated that molecular subtype, presence of ECM, and number of brain metastasis significantly influenced OS after BCBM. By modifying the current GPA model to include more precise characteristics of ECM, the predictive accuracy was further enhanced as indicated by the C-index and RMST curve.
More ECM sites, both bone and visceral invasion and uncontrolled ECM were dismal prognostic factors for survival outcomes of BCBM patients. A new Breast-GPA model with better predictive effect was constructed.
乳腺癌脑转移（BCBM）与不良预后和生活质量下降有关。分级预后评估（GPA）评分模型是预测 BCBM 预后的一种成熟工具。值得注意的是，颅外转移（ECM）的存在被认为是乳腺 GPA 模型中的一个重要预后因素。本研究旨在进一步细化 ECM 的其他特征，以提高对 BCBM 的预后预测。
本研究纳入 2010 年 1 月至 2021 年 7 月在中国医学科学院肿瘤医院住院诊断为 BCBM 的所有患者。根据 ECM 的特征，比较患者的基线特征，包括转移的存在、数量、位置和控制情况。采用 Kaplan-Meier 法和对数秩检验比较总生存期（OS）。采用 Cox 回归分析确定显著的预后因素。将上述 ECM 特征纳入原始乳腺-GPA 模型，以提高其预后准确性。采用一致性指数（C-index）和限制性平均生存时间（RMST）评估和比较更新和原始生存模型的预测准确性。
本研究纳入 284 例 BCBM 患者。Kaplan-Meier 生存曲线表明，诊断为 BCBM 时无 ECM 的患者生存更好（p=0.007）。在 ECM 亚组中，有 3 个以上器官受累、同时有骨和内脏转移以及进展性 ECM 的患者 OS 较差（p=0.003、0.001 和 <0.001）。多变量分析表明，分子亚型、ECM 的存在和脑转移的数量显著影响 BCBM 后的 OS。通过在当前 GPA 模型中加入更精确的 ECM 特征，C-index 和 RMST 曲线表明预测准确性进一步提高。
更多的 ECM 部位、骨和内脏侵犯以及不受控制的 ECM 是 BCBM 患者生存结果的不良预后因素。构建了一种具有更好预测效果的新型乳腺-GPA 模型。
