PURPOSE: Several indices have been developed to predict overall survival (OS) in patients with breast cancer with brain metastases, including the breast graded prognostic assessment (breast-GPA), comprising age, tumor subtype, and Karnofsky performance score. However, number of brain metastases-a highly relevant clinical variable-is less often incorporated into the final model. We sought to validate the existing breast-GPA in an independent larger cohort and refine it integrating number of brain metastases. PATIENTS AND METHODS: Data were retrospectively gathered from a prospectively maintained institutional database. Patients with newly diagnosed brain metastases from 1996 to 2013 were identified. After validating the breast-GPA, multivariable Cox regression and recursive partitioning analysis led to the development of the modified breast-GPA. The performances of the breast-GPA and modified breast-GPA were compared using the concordance index. RESULTS: In our cohort of 1,552 patients, the breast-GPA was validated as a prognostic tool for OS (P < .001). In multivariable analysis of the breast-GPA and number of brain metastases (> three v ≤ three), both were independent predictors of OS. We therefore developed the modified breast-GPA integrating a fourth clinical parameter. Recursive partitioning analysis reinforced the prognostic significance of these four factors. Concordance indices were 0.78 (95% CI, 0.77 to 0.80) and 0.84 (95% CI, 0.83 to 0.85) for the breast-GPA and modified breast-GPA, respectively (P < .001). CONCLUSION: The modified breast-GPA incorporates four simple clinical parameters of high prognostic significance. This index has an immediate role in the clinic as a formative part of the clinician's discussion of prognosis and direction of care and as a potential patient selection tool for clinical trials.
PURPOSE: Several indices have been developed to predict overall survival (OS) in patients with breast cancer with brain metastases, including the breast graded prognostic assessment (breast-GPA), comprising age, tumor subtype, and Karnofsky performance score. However, number of brain metastases-a highly relevant clinical variable-is less often incorporated into the final model. We sought to validate the existing breast-GPA in an independent larger cohort and refine it integrating number of brain metastases. PATIENTS AND METHODS: Data were retrospectively gathered from a prospectively maintained institutional database. Patients with newly diagnosed brain metastases from 1996 to 2013 were identified. After validating the breast-GPA, multivariable Cox regression and recursive partitioning analysis led to the development of the modified breast-GPA. The performances of the breast-GPA and modified breast-GPA were compared using the concordance index. RESULTS: In our cohort of 1,552 patients, the breast-GPA was validated as a prognostic tool for OS (P < .001). In multivariable analysis of the breast-GPA and number of brain metastases (> three v ≤ three), both were independent predictors of OS. We therefore developed the modified breast-GPA integrating a fourth clinical parameter. Recursive partitioning analysis reinforced the prognostic significance of these four factors. Concordance indices were 0.78 (95% CI, 0.77 to 0.80) and 0.84 (95% CI, 0.83 to 0.85) for the breast-GPA and modified breast-GPA, respectively (P < .001). CONCLUSION: The modified breast-GPA incorporates four simple clinical parameters of high prognostic significance. This index has an immediate role in the clinic as a formative part of the clinician's discussion of prognosis and direction of care and as a potential patient selection tool for clinical trials.
Authors: Paul W Sperduto; Brian Berkey; Laurie E Gaspar; Minesh Mehta; Walter Curran Journal: Int J Radiat Oncol Biol Phys Date: 2007-10-10 Impact factor: 7.038
Authors: B C Pestalozzi; D Zahrieh; K N Price; S B Holmberg; J Lindtner; J Collins; D Crivellari; M F Fey; E Murray; O Pagani; E Simoncini; M Castiglione-Gertsch; R D Gelber; A S Coates; A Goldhirsch Journal: Ann Oncol Date: 2006-04-07 Impact factor: 32.976
Authors: Jill S Barnholtz-Sloan; Changhong Yu; Andrew E Sloan; Jaime Vengoechea; Meihua Wang; James J Dignam; Michael A Vogelbaum; Paul W Sperduto; Minesh P Mehta; Mitchell Machtay; Michael W Kattan Journal: Neuro Oncol Date: 2012-04-27 Impact factor: 12.300
Authors: Olivier Graesslin; Bassam S Abdulkarim; Charles Coutant; Florence Huguet; Zsolt Gabos; Limin Hsu; Olivier Marpeau; Serge Uzan; Lajos Pusztai; Eric A Strom; Gabriel N Hortobagyi; Roman Rouzier; Nuhad K Ibrahim Journal: J Clin Oncol Date: 2010-03-22 Impact factor: 44.544
Authors: Aki Morikawa; Lilly Jordan; Raquel Rozner; Sujata Patil; Adrienne Boire; Elena Pentsova; Andrew D Seidman Journal: Clin Breast Cancer Date: 2016-07-25 Impact factor: 3.225
Authors: Christopher S Grubb; Ashish Jani; Cheng-Chia Wu; Shumaila Saad; Yasir H Qureshi; Tavish Nanda; Andrew Yaeh; Tzlil Rozenblat; Michael B Sisti; Jeffrey N Bruce; Guy M McKhann; Sameer A Sheth; Jeraldine Lesser; Simon K Cheng; Steven R Isaacson; Andrew B Lassman; Eileen P Connolly; Tony J C Wang Journal: J Neurooncol Date: 2015-11-28 Impact factor: 4.130
Authors: Anurag Saraf; Christopher S Grubb; Mark E Hwang; Cheng-Hung Tai; Cheng-Chia Wu; Ashish Jani; Matthew E Lapa; Jacquelyn I S Andrews; Sierra Vanderkelen; Steven R Isaacson; Adam M Sonabend; Sameer A Sheth; Guy M McKhann; Michael B Sisti; Jeffrey N Bruce; Simon K Cheng; Eileen P Connolly; Tony J C Wang Journal: J Neurooncol Date: 2017-07-03 Impact factor: 4.130
Authors: Paul W Sperduto; Shane Mesko; Jing Li; Daniel Cagney; Ayal Aizer; Nancy U Lin; Eric Nesbit; Tim J Kruser; Jason Chan; Steve Braunstein; Jessica Lee; John P Kirkpatrick; Will Breen; Paul D Brown; Diana Shi; Helen A Shih; Hany Soliman; Arjun Sahgal; Ryan Shanley; William Sperduto; Emil Lou; Ashlyn Everett; Drexell Hunter Boggs; Laura Masucci; David Roberge; Jill Remick; Kristin Plichta; John M Buatti; Supriya Jain; Laurie E Gaspar; Cheng-Chia Wu; Tony J C Wang; John Bryant; Michael Chuong; James Yu; Veronica Chiang; Toshimichi Nakano; Hidefumi Aoyama; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2020-02-19 Impact factor: 7.038
Authors: José P Leone; Bjarni Haraldsson; Sarah L Mott; Bradley D McDowell; Elizabeth A Chrischilles Journal: Am J Clin Oncol Date: 2019-01 Impact factor: 2.339
Authors: Matthew N Mills; Chetna Thawani; Nicholas B Figura; Daniel E Oliver; Aixa E Soyano; Arnold Etame; Timothy J Robinson; James K Liu; Michael A Vogelbaum; Peter A Forsyth; Brian J Czerniecki; Hatem H Soliman; Hyo S Han; Hsiang-Hsuan Michael Yu; Kamran A Ahmed Journal: J Neurooncol Date: 2021-03-19 Impact factor: 4.130
Authors: Weijun Wang; Haiping He; Nagore I Marín-Ramos; Shan Zeng; Steven D Swenson; Hee-Yeon Cho; Jie Fu; Paul M Beringer; Josh Neman; Ligang Chen; Axel H Schönthal; Thomas C Chen Journal: Neuro Oncol Date: 2021-10-01 Impact factor: 12.300