Breast cancer patients with brain metastases or leptomeningeal disease: 10-year results of a national cohort with validation of prognostic indexes
Breast cancer patients with brain metastases or leptomeningeal disease: 10-year results of a national cohort with validation of prognostic indexes
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DOI：
10.1111/tbj.13433
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发表时间：
2019-11-01
期刊：
影响因子：
2.1
通讯作者：
Ratosa, Ivica
中科院分区：
文献类型：
--
作者：
Znidaric, Tanja;Gugic, Jasenka;Ratosa, Ivica
乳腺癌（BC）患者脑转移（BM）和软脑膜（LM）疾病的发展表明预后不良，并损害患者的生活质量。BM的预后生存评分可以帮助预测预期生存期，以选择最合适的治疗方法。本研究的目的是分析全国范围内接受BM/LM疾病放疗的BC患者的数据，并验证不同生存预后评分的适用性。我们回顾性评价了2005年4月至2015年12月期间接受放射治疗的423例BM/LM疾病BC患者的医疗记录。根据BC递归分配分析（B-RPA）、乳腺分级预后评估（Breast-GPA）、改良乳腺分级预后评估（MB-GPA）和BC BM患者的简单生存评分（SS-BM）对患者进行分类。总生存期（OS）从BM/LM疾病发展至死亡或末次随访日期计算。中位随访7.5年后，中位OS为6.9个月（95% CI 5.5-7.8，范围0-146.4），1年和2年生存率分别为35%和17%。生存分析显示，生物学亚型的中位OS存在显著差异（P < 0.0001），如下：3.2（95%置信区间（CI）2.5-3.9），3.9（95% CI 2.3-5.6），7.1（95% CI 4.3-9.8），12.1（95% CI 8.3-15.9）和15.4原发性三阴性BC（TNBC）、管腔B HER 2阴性、管腔A、HER 2富集和管腔B HER 2阳性肿瘤的（95% CI 8.8-22.1）个月，分别在单变量和多变量分析中，良好的Karnofsky体能状态（KPS）、单一转移和无LM或颅外疾病均显示出更好的OS。所有四个预后指标提供了良好的预后价值预测生存。SS-BM和MB-GPA的鉴别能力最强（一致性指数C分别为0.768和0.738）。本研究是验证BM/LM BC患者预后评分的最大单机构系列研究之一。SS-BM和MB-GPA被证明是临床决策过程中有用的工具。
Development of brain metastasis (BM) and leptomeningeal (LM) disease in breast cancer (BC) patients indicates poor prognosis and impairs patients' quality of life. Prognostic survival scores for BM can help predict expected survival in order to choose the most appropriate treatment. The aim of our study was to analyze national data for BC patients treated with radiation therapy for BM/LM disease and validate the applicability of different survival prognostic scores. We retrospectively evaluated medical records of 423 BC patients with BM/LM disease receiving radiation therapy between April 2005 and December 2015. Patients were classified by BC Recursive Partitioning Analysis (B-RPA), Breast Graded Prognostic Assessment (Breast-GPA), Modified Breast Graded Prognostic Assessment (MB-GPA), and Simple Survival score for patients with BM from BC (SS-BM). Overall survival (OS) was calculated from the development of BM/LM disease to death or last follow-up date. After a median follow-up of 7.5 years, the median OS was 6.9 months (95% CI 5.5-7.8, range 0-146.4) and 1- and 2-year survival rates were 35% and 17%, respectively. Survival analysis showed significant differences in median OS regarding biologic subtypes (P < 0.0001), as follows: 3.2 (95% Confidence Interval (CI) 2.5-3.9), 3.9 (95% CI 2.3-5.6), 7.1 (95% CI 4.3-9.8), 12.1 (95% CI 8.3-15.9), and 15.4 (95% CI 8.8-22.1) months for primary triple-negative BC (TNBC), Luminal B HER2-negative, Luminal A, HER2-enriched, and Luminal B HER2-positive tumors, respectively. Good Karnofsky Performance Status (KPS), single metastasis, and absence of LM or extracranial disease all demonstrated better OS in univariate and multivariate analysis. All four employed prognostic indexes provided good prognostic value in predicting survival. SS-BM and MB-GPA showed the best discriminating ability (Concordance indexes C were 0.768 and 0.738, respectively). This study presents one of the largest single-institution series validating prognostic scores for BC patients with BM/LM. SS-BM and MB-GPA proved to be useful tools in the clinical decision-making process.