TY - JOUR
T1 - External validation of Modified Breast Graded Prognostic Assessment for breast cancer patients with brain metastases
T2 - A multicentric European experience
AU - Griguolo, Gaia
AU - Jacot, William
AU - Kantelhardt, Eva
AU - Dieci, Maria Vittoria
AU - Bourgier, Céline
AU - Thomssen, Christoph
AU - Bailleux, Caroline
AU - Miglietta, Federica
AU - Braccini, Antoine Laurent
AU - Conte, Pier Franco
AU - Ferrero, Jean Marc
AU - Guarneri, Valentina
AU - Darlix, Amélie
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background Several prognostic scores have been developed to estimate survival of breast cancer (BC) patients with brain metastases (BM). Modified Breast Graded Prognostic Assessment (GPA), based on a single-institution cohort of 1552 patients, has been proposed as refinement of Breast-GPA. In addition to age, tumour subtype and KPS, Modified Breast-GPA comprises number of BM. This study was designed to validate Modified Breast-GPA. Patients and methods Clinical data of 668 BC patients diagnosed with BM at four institutions between 1996 and 2016 were reviewed. Patients were classified by Breast-GPA and Modified Breast-GPA. Overall survival (OS) was calculated from time of BM diagnosis to death or last follow-up. Cox proportional models were used to calculate hazard-ratios and their 95% CI. The performances of Breast-GPA and Modified Breast-GPA were compared using Harrell's concordance index. Results Median age at BM diagnosis was 56 years (range 24–85). At last follow-up, 632 patients (94.6%) had died. Median OS was 8.1 months (95% CI 6.9–9.4). The number of BM (1–3 vs. >3) was significantly associated with OS in univariate analysis (p < 0.001) and having >3 BM was identified as a negative prognostic factor in multivariate analysis. Both Breast-GPA and Modified Breast-GPA accurately predicted OS (p < 0.001 for both scores). Performance of Modified Breast-GPA was better: concordance indices were 0.6390 (95% CI, 0.6381 to 0.6399) and 0.6647 (95% CI, 0.6639 to 0.6655) for Breast-GPA and Modified Breast-GPA, respectively (p < 0.001). Conclusions This work provides the first external independent validation of Modified Breast-GPA and confirms its better performance as compared to Breast-GPA.
AB - Background Several prognostic scores have been developed to estimate survival of breast cancer (BC) patients with brain metastases (BM). Modified Breast Graded Prognostic Assessment (GPA), based on a single-institution cohort of 1552 patients, has been proposed as refinement of Breast-GPA. In addition to age, tumour subtype and KPS, Modified Breast-GPA comprises number of BM. This study was designed to validate Modified Breast-GPA. Patients and methods Clinical data of 668 BC patients diagnosed with BM at four institutions between 1996 and 2016 were reviewed. Patients were classified by Breast-GPA and Modified Breast-GPA. Overall survival (OS) was calculated from time of BM diagnosis to death or last follow-up. Cox proportional models were used to calculate hazard-ratios and their 95% CI. The performances of Breast-GPA and Modified Breast-GPA were compared using Harrell's concordance index. Results Median age at BM diagnosis was 56 years (range 24–85). At last follow-up, 632 patients (94.6%) had died. Median OS was 8.1 months (95% CI 6.9–9.4). The number of BM (1–3 vs. >3) was significantly associated with OS in univariate analysis (p < 0.001) and having >3 BM was identified as a negative prognostic factor in multivariate analysis. Both Breast-GPA and Modified Breast-GPA accurately predicted OS (p < 0.001 for both scores). Performance of Modified Breast-GPA was better: concordance indices were 0.6390 (95% CI, 0.6381 to 0.6399) and 0.6647 (95% CI, 0.6639 to 0.6655) for Breast-GPA and Modified Breast-GPA, respectively (p < 0.001). Conclusions This work provides the first external independent validation of Modified Breast-GPA and confirms its better performance as compared to Breast-GPA.
KW - Brain metastases
KW - Breast cancer
KW - Graded Prognostic Assessment
KW - Modified Breast Graded Prognostic Assessment
KW - Prognosis
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U2 - 10.1016/j.breast.2017.10.006
DO - 10.1016/j.breast.2017.10.006
M3 - Article
AN - SCOPUS:85031996819
VL - 37
SP - 36
EP - 41
JO - Breast
JF - Breast
SN - 0960-9776
ER -