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Multicenter Study
. 2012 Apr 1;82(5):2111-7.
doi: 10.1016/j.ijrobp.2011.02.027. Epub 2011 Apr 15.

Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases

Paul W Sperduto  1 , Norbert Kased, David Roberge, Zhiyuan Xu, Ryan Shanley, Xianghua Luo, Penny K Sneed, Samuel T Chao, Robert J Weil, John Suh, Amit Bhatt, Ashley W Jensen, Paul D Brown, Helen A Shih, John Kirkpatrick, Laurie E Gaspar, John B Fiveash, Veronica Chiang, Jonathan P S Knisely, Christina Maria Sperduto, Nancy Lin, Minesh Mehta
Affiliations
Multicenter Study

Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases

Paul W Sperduto et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: The diagnosis-specific Graded Prognostic Assessment (GPA) was published to clarify prognosis for patients with brain metastases. This study refines the existing Breast-GPA by analyzing a larger cohort and tumor subtype.

Methods and materials: A multi-institutional retrospective database of 400 breast cancer patients treated for newly diagnosed brain metastases was generated. Prognostic factors significant for survival were analyzed by multivariate Cox regression and recursive partitioning analysis (RPA). Factors were weighted by the magnitude of their regression coefficients to define the GPA index.

Results: Significant prognostic factors by multivariate Cox regression and RPA were Karnofsky performance status (KPS), HER2, ER/PR status, and the interaction between ER/PR and HER2. RPA showed age was significant for patients with KPS 60 to 80. The median survival time (MST) overall was 13.8 months, and for GPA scores of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 were 3.4 (n = 23), 7.7 (n = 104), 15.1 (n = 140), and 25.3 (n = 133) months, respectively (p < 0.0001). Among HER2-negative patients, being ER/PR positive improved MST from 6.4 to 9.7 months, whereas in HER2-positive patients, being ER/PR positive improved MST from 17.9 to 20.7 months. The log-rank statistic (predictive power) was 110 for the Breast-GPA vs. 55 for tumor subtype.

Conclusions: The Breast-GPA documents wide variation in prognosis and shows clear separation between subgroups of patients with breast cancer and brain metastases. This tool will aid clinical decision making and stratification in clinical trials. These data confirm the effect of tumor subtype on survival and show the Breast-GPA offers significantly more predictive power than the tumor subtype alone.

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Figures

Figure 1
Figure 1. Recursive Partitioning Analysis Model
Ellipses represent internal nodes; rectangles represent terminal nodes (nodes for which no additional splitting can improve the model). The top number within each node is the number of patients in that node; the bottom is the median survival time and its 95% CI.
Figure 2
Figure 2. Kaplan-Meier Survival Curves for Breast-GPA Groups
Group 1: GPA 0.0–1.0, MST 3.4 months (n = 23) Group 2: GPA 1.5–2.0, MST 7.7 months (n = 104) Group 3: GPA 2.5–3.0, MST 15.1 months (n = 140) Group 4: GPA 3.5–4.0, MST 25.3 months (n = 133)
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