Validation and Development of a Modified Breast Graded Prognostic Assessment As a Tool for Survival in Patients With Breast Cancer and Brain Metastases
Validation and Development of a Modified Breast Graded Prognostic Assessment As a Tool for Survival in Patients With Breast Cancer and Brain Metastases
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DOI：
10.1200/jco.2014.58.8517
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发表时间：
2015-07-10
影响因子：
45.3
通讯作者：
Gonzalez-Angulo, Ana M.
中科院分区：
文献类型：
--
作者：
Subbiah, Ishwaria M.;Lei, Xiudong;Gonzalez-Angulo, Ana M.
目的预测乳腺癌脑转移患者的总生存期(OS)，包括乳腺癌分级预后评估(BRAST-GPA)，包括年龄、肿瘤亚型和Karnofsky功能评分。然而，脑转移瘤的数量--一个高度相关的临床变量--较少被纳入最终模型.我们试图在一个独立的更大的队列中验证现有的乳腺GPA，并结合脑转移瘤的数量进行提炼。患者和方法数据来自一个前瞻性维护的机构数据库。确定了1996至2013年间新诊断为脑转移瘤的患者。在验证了BREAM-GPA之后，多变量COX回归和递归分割分析导致了改进的BREAM-GPA的发展。结果在我们1,552名患者的队列中，乳腺GPA被确认为OS的预后工具(P<；.001)。在对乳腺GPA和脑转移数目(>；三比三)的多变量分析中，两者都是OS的独立预测因素。因此，我们开发了改进的BREAM-GPA，集成了第四个临床参数。递归分割分析强化了这四个因素的预后意义。一致性指数分别为0.78(95%CI，0.77~0.80)和0.84(95%CI，0.83~0.85)(P<；.001)。这一指标在临床上具有立竿见影的作用，作为临床医生讨论预后和护理方向的形成部分，并作为临床试验的潜在患者选择工具。(C)2015年度美国临床肿瘤学会
PurposeSeveral 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 metastasesa highly relevant clinical variableis 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 MethodsData 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.ResultsIn 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).ConclusionThe 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. (C) 2015 by American Society of Clinical Oncology