Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16-12)open access
- Kim, Jae Sik; Kim, Kyubo; Jung, Wonguen; Shin, Kyung Hwan; Im, Seock-Ah; Kim, Hee-Jun; Kim, Yong Bae; Chang, Jee Suk; Choi, Doo Ho; Park, Yeon Hee; Kim, Dae Yong; Kim, Tae Hyun; Choi, Byung Ock; Lee, Sea-Won; Kim, Suzy; Kwon, Jeanny; Kang, Ki Mun; Chung, Woong-Ki; Kim, Kyung Su; Nam, Ji Ho; Yoon, Won Sup; Kim, Jin Hee; Cha, Jihye; Oh, Yoon Kyeong; Kim, In Ah
- Issue Date
- CHURCHILL LIVINGSTONE
- Breast cancer; Brain metastasis; Overall survival; Prognostic model; Whole brain radiotherapy
- BREAST, v.49, pp.41 - 47
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- Purpose: This study evaluated the influence of prognostic factors and whole brain radiotherapy (WBRT) on overall survival (OS) of breast cancer (BC) patients with brain metastases (BM). Methods and materials: Medical records of 730 BC patients diagnosed with BM from 2000 to 2014 at 17 institutions were retrospectively reviewed. OS was calculated from BM diagnosis. Median follow-up duration was 11.9 months (range, 0.1-126.2). Results: Median OS was 15.0 months (95% CI: 14.0-16.9). Patients with different BC-specific graded prognostic assessment (GPA) scores showed significant differences (p < 0.001) in OS. In multivariate analysis, histologic grade 3 (p = 0.014), presence of extracranial metastasis (p <0.001), the number of BM (>4; p = 0.002), hormone receptor negativity (p = 0.005), HER2-negativity (p = 0.003), and shorter time interval (<30 months) between BC and BM diagnosis (p = 0.007) were associated with inferior OS. By summing the beta-coefficients of variables that were prognostic in multivariate analyses, we developed a prognostic model that stratified patients into low-risk (<= 0.673) and high-risk (>0.673) subgroups; the high-risk subgroup had poorer median OS (10.1 months, 95% CI: 7.9-11.9 vs. 21.9 months, 95% CI: 19.5 -27.1, p <0.001). Univariate and multivariate analyses of propensity score-matched patients diagnosed with BM >= 30 months after BC diagnosis (n = 389, "late BM") revealed that WBRT-treated patients showed superior OS compared to non-WBRT-treated patients (p = 0.070 and 0.030, respectively). Conclusion: Our prognostic model identified high-risk BC patients with BM who might benefit from increased surveillance; if validated, our model could guide treatment selection for such patients. Patients with late BM might benefit from WBRT as initial local treatment. (C) 2019 Elsevier Ltd.
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