EFFECT OF TUMOR SUBTYPE ON SURVIVAL AND THE GRADED PROGNOSTIC ASSESSMENT FOR PATIENTS WITH BREAST CANCER AND BRAIN METASTASES

被引：277

作者：

Sperduto, Paul W. ^{[1
]}

Kased, Norbert ^{[2
]}

Roberge, David ^{[3
]}

Xu, Zhiyuan ^{[4
]}

Shanley, Ryan ^{[5
]}

Luo, Xianghua ^{[5
,6
]}

Sneed, Penny K. ^{[2
]}

Chao, Samuel T. ^{[7
]}

Weil, Robert J. ^{[4
]}

Suh, John ^{[7
]}

Bhatt, Amit ^{[8
]}

Jensen, Ashley W. ^{[9
]}

Brown, Paul D. ^{[9
]}

Shih, Helen A. ^{[10
]}

Kirkpatrick, John ^{[11
]}

Gaspar, Laurie E. ^{[12
]}

Fiveash, John B. ^{[13
]}

Chiang, Veronica ^{[14
,15
]}

Knisely, Jonathan P. S. ^{[15
,16
]}

Sperduto, Christina Maria ^{[17
]}

Lin, Nancy ^{[18
]}

Mehta, Minesh ^{[19
]}

机构：

[1] Univ Minnesota Gamma Knife, Minneapolis, MN USA

[2] Univ Calif San Francisco, Dept Radiat Oncol, San Francisco, CA USA

[3] McGill Univ, Ctr Hlth, Montreal, PQ, Canada

[4] Cleveland Clin, Dept Neurosurg, Cleveland, OH 44106 USA

[5] Univ Minnesota, Mason Canc Ctr, Minneapolis, MN USA

[6] Univ Minnesota, Sch Publ Hlth, Div Biostat, Minneapolis, MN 55455 USA

[7] Cleveland Clin, Dept Radiat Oncol, Cleveland, OH 44106 USA

[8] Univ Wisconsin, Dept Human Oncol, Madison, WI USA

[9] Mayo Clin, Dept Radiat Oncol, Rochester, MN USA

[10] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Radiat Oncol, Boston, MA USA

[11] Duke Univ, Med Ctr, Dept Radiat Oncol, Durham, NC USA

[12] Univ Colorado, Sch Med, Dept Radiat Oncol, Aurora, CO USA

[13] Univ Alabama Birmingham, Med Ctr, Birmingham, AL 35294 USA

[14] Yale Univ, Sch Med, Dept Neurosurg, New Haven, CT USA

[15] Yale Canc Ctr, New Haven, CT USA

[16] Yale Univ, Sch Med, Dept Radiat Oncol, New Haven, CT USA

[17] Dartmouth Coll, Hanover, NH 03755 USA

[18] Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA

[19] Northwestern Univ, Dept Radiat Oncol, Chicago, IL 60611 USA

来源：

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2012年 / 82卷 / 05期

基金：

美国国家卫生研究院;

关键词：

Breast cancer; Brain metastases; Prognosis; Radiation therapy; Stereotactic radiosurgery; Estrogen; Progesterone; HER2; Outcomes; PARTITIONING ANALYSIS RPA; RANDOMIZED PHASE-III; STEREOTACTIC RADIOSURGERY; ADJUVANT CHEMOTHERAPY; DISTANT RECURRENCE; ESTROGEN-RECEPTOR; RADIOTHERAPY; TRASTUZUMAB; RADIATION; THERAPY;

D O I：

10.1016/j.ijrobp.2011.02.027

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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. (C) 2012 Elsevier Inc.

引用

页码：2111 / 2117

页数：7

共 56 条

[1] Stereotactic radiosurgical treatment of cerebral metastases arising from breast cancer [J].