Addition of Number of Metastases Improves Prognostic Assessment Tool in Breast Cancer With Brain Metastases
As reported in the Journal of Clinical Oncology by Subbiah et al, the addition of number of brain metastases to the breast graded prognostic assessment (breast-GPA) tool improved the prediction of overall survival in breast cancer patients with brain metastases. The existing breast-GPA includes age, tumor subtype, and Karnofsky performance score.
Study Details
The study involved data from 1,552 patients with brain metastases newly diagnosed between 1996 and 2013 from the prospectively maintained database at MD Anderson Cancer Center. The breast-GPA was validated as a prognostic tool for overall survival in this cohort (P < .001). Median overall survival was 3.1, 6.3, 15.5, and 26 months for patients with breast-GPA scores of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0.
Modified Breast-GPA
In multivariate analysis of the breast-GPA and the number of brain metastases, breast-GPA scores of 2.5 to 3.0 (hazard ratio [HR] = 1.82, P < .001, vs score of 3.5–4.0), 1.5 to 2.0 (HR = 3.58, P < .001), and 0 to 1.0 (HR = 11.22, P < .001) and the presence of more than three vs one to three brain metastases (HR = 1.73, P <.001) were independent predictors of overall survival.
Median overall survival using a modified breast-GPA incorporating the number of brain metastases was 2.6, 9.2, 19.9, and 28.8 months for patients with scores of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 (P < .001). Concordance indices were 0.78 (95% confidence interval [CI] = 0.77–0.80) for the existing breast-GPA vs 0.84 (95% CI = 0.83–0.85) for the modified breast-GPA (P < .001).
The investigators concluded: “The 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.”
Debu Tripathy, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
The study was supported by the American Cancer Society and the Commonwealth Foundation for Cancer Research. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
