Prognostic index for patients with brain metastases from breast cancer: A validation and refinement of the breast-specific graded prognostic assessment (GPA) index.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 1097-1097 ◽  
Author(s):  
H. K. Ahn ◽  
S. Lee ◽  
J. H. Sohn ◽  
S. Park ◽  
Y. H. Ham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Prognostic Index ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

A validation study of a new prognostic index for patients with brain metastases: the Graded Prognostic Assessment

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 87-89 ◽  
Author(s):  
Christina Maria Sperduto ◽  
Yoichi Watanabe ◽  
John Mullan ◽  
Terry Hood ◽  
Gregg Dyste ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Validation Study ◽  
Radiation Therapy Oncology Group ◽  
Prognostic Index ◽  
Survival Duration ◽  
University Of Minnesota ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment ◽  
The University

Object The purpose of this study was to validate a new prognostic index for patients with brain metastases. This index, the Graded Prognostic Assessment (GPA), is based on an analysis of 1960 patients whose data were extracted from the Radiation Therapy Oncology Group (RTOG) database. The GPA is based on 4 criteria: age, Karnofsky Performance Scale score, number of brain metastases, and the presence/absence of extracranial metastases. Each of the 4 criteria is given a score of 0, 0.5, or 1.0, so the patient with best prognosis would have a GPA score of 4.0. Methods Between April 2005 and December 2006, 140 eligible patients with brain metastases were treated at the Gamma Knife Center at the University of Minnesota. The GPA score was calculated for each patient, and the score was then correlated with survival. Survival duration was calculated from the date treatment began for the brain metastases. Eligibility criteria included patients treated with whole-brain radiation therapy, stereotactic radiosurgery, or both. Results The median survival time in months observed in the RTOG and Minnesota data by GPA score was as follows: GPA 3.5–4.0, 11.0 and 21.7; GPA 3.0, 8.9 and 17.5; GPA 1.5–2.5, 3.8 and 5.9; and GPA 0–1.0, 2.6 and 3.0, respectively. Conclusions The University of Minnesota data correlate well with the RTOG data and validate the use of the GPA as an effective prognostic index for patients with brain metastases. Clearly, not all patients with brain metastases have the same prognosis, and treatment decisions should be individualized accordingly. The GPA score does appear to be as prognostic as the RPA and is less subjective (because the RPA requires assessment of whether the primary disease is controlled), more quantitative, and easier to use and remember. A multiinstitutional validation study of the GPA is ongoing.

Graded prognostic assessment index for melanoma with brain metastases (MBM).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9086-9086 ◽  
Author(s):  
Kwabena Osei-Boateng ◽  
Vyshak Alva Venur ◽  
Saurabh Dahiya ◽  
Lingling Du ◽  
Rohan Garje ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Proportional Hazards ◽  
Cleveland Clinic ◽  
Prognostic Index ◽  
Whole Brain Radiotherapy ◽  
Median Number ◽  
Cox Proportional Hazards ◽  
Karnofsky Performance Scale ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

9086 Background: The Graded Prognostic Assessment (GPA) is a commonly used prognostic index in patients with brain metastases (BM). GPA for melanoma consists of Karnofsky Performance Scale (KPS) and the number of BM present. The purpose of this study was to evaluate the utility of GPA index in a contemporary cohort of patients (pts) with MBM at a single institution to predict Overall Survival (OS). Methods: With IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify pts with MBM treated between 2000-2012. The primary endpoint was OS from diagnosis of MBM. Cox proportional hazards models were used for data analysis. Stepwise variable selection was used to identify independent prognostic factors. Results: 90 MBM (51 females) median age 57 years (range 24-87) were included for analysis. The median number of BM was 2 (range, 1-11). KPS was 90-100(52%), 70-80 (43%) and <70 (6%). Extracranial metastases was present in 75 patients (83%). Initial treatment included Stereotactic Radiosurgery (SRS) (49%), Whole Brain Radiotherapy (WBRT) (8%), WBRT + SRS (22%), WBRT + Surgery (S)(14%) and SRS + (S) (7%). Median OS was 7.8 months (95% C.I. 6.8-10.1). GPA was prognostic for OS ( p=0.01), however this was because pts with scores of 4 had worse outcomes (median 5.1months) than the other 3 groups, which had similar OS (median 9.0-12.8 months). In addition, number of BM was not associated with OS (p=0.19). In contrast, KPS (p=0.02), Liver (p=0.04) and hemorrhagic metastasis (p=0.02) were independently prognostic for OS. These factors can be used to derive a new prognostic index with 3 groups: Unfavorable, Intermediate and Favorable (see Table). Conclusions: GPA was prognostic for OS in pts with MBM, however separation of the groups was not clear. A new prognostic index consisting of KPS, liver and hemorrhagic metastases is proposed for MBM. [Table: see text]

Graded prognostic assessment (GPA) of HER2 positive breast cancer patients with brain metastases.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 589-589
Author(s):  
Ming Chi ◽  
Vyshak Alva Venur ◽  
Alireza Mohammad Mohammadi ◽  
Samuel T. Chao ◽  
G. Thomas Budd ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment ◽  
Positive Breast Cancer

scholarly journals Validation and Development of a Modified Breast Graded Prognostic Assessment As a Tool for Survival in Patients With Breast Cancer and Brain Metastases

2015 ◽  
Vol 33 (20) ◽  
pp. 2239-2245 ◽  
Author(s):  
Ishwaria M. Subbiah ◽  
Xiudong Lei ◽  
Jeffrey S. Weinberg ◽  
Erik P. Sulman ◽  
Mariana Chavez-MacGregor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Recursive Partitioning ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Recursive Partitioning Analysis ◽  
Clinical Variable ◽  
Karnofsky Performance Score ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

Purpose Several indices have been developed to predict overall survival (OS) in patients with breast cancer with brain metastases, including the breast graded prognostic assessment (breast-GPA), comprising age, tumor subtype, and Karnofsky performance score. However, number of brain metastases—a highly relevant clinical variable—is less often incorporated into the final model. We sought to validate the existing breast-GPA in an independent larger cohort and refine it integrating number of brain metastases. Patients and Methods Data were retrospectively gathered from a prospectively maintained institutional database. Patients with newly diagnosed brain metastases from 1996 to 2013 were identified. After validating the breast-GPA, multivariable Cox regression and recursive partitioning analysis led to the development of the modified breast-GPA. The performances of the breast-GPA and modified breast-GPA were compared using the concordance index. Results In our cohort of 1,552 patients, the breast-GPA was validated as a prognostic tool for OS (P < .001). In multivariable analysis of the breast-GPA and number of brain metastases (> three v ≤ three), both were independent predictors of OS. We therefore developed the modified breast-GPA integrating a fourth clinical parameter. Recursive partitioning analysis reinforced the prognostic significance of these four factors. Concordance indices were 0.78 (95% CI, 0.77 to 0.80) and 0.84 (95% CI, 0.83 to 0.85) for the breast-GPA and modified breast-GPA, respectively (P < .001). Conclusion 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.

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