Graded prognostic assessment index for breast cancer patients with brain metastases (BCBM).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2096-2096
Author(s):  
Vyshak Alva Venur ◽  
Saurabh Dahiya ◽  
Lingling Du ◽  
Rohan Garje ◽  
Kwabena Osei-Boateng ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Tertiary Care ◽  
Prognostic Assessment ◽  
Hazards Model ◽  
Graded Prognostic Assessment ◽  
Extracranial Metastases

2096 Background: The Graded Prognostic Assessment (GPA) is a commonly used prognostic index based on RTOG protocols in patients with brain metastases (BM). The purpose of this study was to evaluate prognostic factors to predict for overall survival (OS) in breast cancer BM (BCBM) treated at a single tertiary care center. Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify BCBM who were treated in the recent years (2000-12). A proportional hazards model was used to assess OS, which was measured from the date of diagnosis of brain metastases to death or last follow-up. Results: 161 BCBM (160 females) median age 52 years (range 27-84) were included for analysis. 48% of patients were ER positive, 31% were PR positive, 50% were HER2 positive while 31% of patients were triple negative. The median number of BM was 2 (range, 1-15). Karnofsky Performance Scale (KPS) of the patient was 90-100 in 50%, 70-80 in 47%) and <70 in 43%. Extracranial Metastases was present in 85% of patients. Overall 85% of patients had died at the time of analysis; median OS was 19.0 months (95% C.I. 15.7-23.2). Breast GPA that includes age, KPS and subtype was 0-1.0 in 5%, 1.5-2 in 31%, 2.5-3 in 35% and 3.5-4 in 29% of patients. Although GPA was statistically significant (p=0.002), some but not all of the factors used to derive it were significant (KPS [p=0.05],subtype [p=0.003] age [p=0.50]). Factors noted to be independently prognostic for OS (multivariable Cox proportional hazards model) included location of BM, number of extracranial metastases and uncontrolled primary tumor (Table). Conclusions: New GPA based on a set of independent prognostic factors is proposed. [Table: see text]

Prognostic Factors and Survival Outcomes among Patients with Breast Cancer and Brain Metastases at Diagnosis: A National Cancer Database Analysis

Oncology ◽  
2021 ◽  
Vol 99 (5) ◽  
pp. 280-291
Author(s):  
Brittney S. Zimmerman ◽  
Danielle Seidman ◽  
Krystal P. Cascetta ◽  
Meng Ru ◽  
Erin Moshier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Breast Cancer Diagnosis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
National Cancer Database ◽  
Hazards Model ◽  
Sites Of Metastases

Introduction: The aim of this study was to assess for clinicopathologic and socioeconomic features that predict improved survival for patients with advanced breast cancer with synchronous brain metastases at diagnosis. Methods: We utilized the National Cancer Database (NCDB) to identify all patients with brain metastases present at diagnosis, with adequate information on receptor status (ER, PR, Her2), clinical T stage of cT1-4, clinical M1, with 3,943 patients available for analysis. The association between brain metastases patterns and patient/disease variables was examined by robust Poisson regression model. Cox proportional hazards model was used to quantify the associations between overall survival (OS) and these variables. Results: In univariable analysis, OS was significantly associated with the number of sites of metastases (p < 0.0001). Patients with 2 or more additional extracranial sites of metastases had significantly worse OS (median 8.8 months, 95% confidence interval [CI] 7.8, 9.9) than patients with brain metastases only (median OS 10.6 months, 95% CI 9.4, 12.9) or brain metastases plus one other extracranial site of metastases (median OS 13.1 months, 95% CI 11.8, 14.4). Risk factors which predicted poor prognosis included triple-negative disease, high comorbidity score, poorly differentiated tumors, invasive lobular histology, multi-organ involvement of metastases, and government or lack of insurance. Factors which improve survival include younger age and Hispanic race. Discussion/Conclusion: Using a large NCDB, we identified various factors associated with prognosis for patients with brain metastases at the time of breast cancer diagnosis. Insurance status and related socioeconomic challenges provide potential areas for improvement in care for these patients. This information may help stratify patients into prognostic categories at the time of diagnosis to improve treatment plans.

scholarly journals The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 238-238 ◽  
Author(s):  
P. W. Sperduto ◽  
N. Kased ◽  
D. Roberge ◽  
R. Shanley ◽  
S. T. Chao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Predictive Power ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Rank Statistic ◽  
Tumor Subtype ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

238 Background: The Diagnosis-Specific Graded Prognostic Assessment (DS-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: 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 (MCR) and recursive partitioning analysis (RPA). Factors were weighted by magnitude of their regression coefficients to define the GPA index. A GPA score of 4.0 represents the best prognosis, 0.0, the worst. Results: Significant prognostic factors by MCR 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 60-80. The median survival time (MST) overall was 13.8 months, and for GPA scores of 0-1.0, 1.5-2.0, 2.5-3.0 and 3.5-4.0 was 3.4 (n=23), 7.7 (n=104), 15.1 (n=140) and 25.3 (n=133) months, respectively (p < 0.0001). See table. 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 versus 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 of 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. [Table: see text]

A validation study of graded prognostic assessment index for lung cancer patients with brain metastases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2070-2070 ◽  
Author(s):  
Lingling Du ◽  
Vyshak Alva Venur ◽  
Saurabh Dahiya ◽  
Rohan Garje ◽  
Kwabena Osei-Boateng ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Cancer Patients ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Cleveland Clinic ◽  
Lung Cancer Patients ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment ◽  
Extracranial Metastases

2070 Background: The Graded Prognostic Assessment (GPA) is a commonly used index based on 5 prior randomized trials performed by the RTOG (Protocols 7916, 8528, 8905, 9104, and 9508). The purpose of this study was to validate GPA index in a recent cohort of lung cancer patients with brain metastases (LBM) at a larger tertiary care center. Methods: Cleveland Clinic Brain Tumor and Neuro-Oncology Center's database was used to identify LBM treated in the recent era (2000-12). A proportional hazards model was used to assess overall survival (OS), measured from the date of diagnosis of brain metastases to death or last follow-up. Results: 490 LBM (250 males) median age 61 years (range 35-86) were included. Histology included small cell (64, 13%) adenocarcinoma (289, 59%), squamous (53, 11%), large cell (26, 5%) and unknown (55, 11%). The median number of brain metastases was 1 (range, 1-47). Karnofsky Performance Scale (KPS) was 90-100 in 187 (41%), 70-80 in 238 (52%) and <70 in 33 (7%). Extracranial Metastases was present in 327 patients (67%). OS was 14.1 months (95% C.I. 12.3-15.7). GPA for lung cancer is derived from KPS, the number of brain mets, the presence/absence of extracranial metastases, and age. GPA was 0-1.0 in 83 patients, 1.5-2 in 211, 2.5-3 in 135 and 3.5-4 in 18 patients. Although overall GPA was prognostic for survival (p<.0001), not all of the factors used to derive it were significant (Table). Factors noted to be prognostic for survival included primary controlled (p=<.0001), squamous cell histology (p=.0001), age (p=.0002), KPS (p=.0002). The new index divided the patients into unfavorable, intermediate, favorable that was prognostic for survival in this cohort (p<.0001). Conclusions: New index developed based on a revised set of independent prognostic factors (primary controlled, squamous cell histology, age and performance status) is proposed. [Table: see text]

scholarly journals Epidemiology of synchronous brain metastases

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Raj Singh ◽  
Kelsey C Stoltzfus ◽  
Hanbo Chen ◽  
Alexander V Louie ◽  
Eric J Lehrer ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Renal Pelvis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Lung Metastases ◽  
Descriptive Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Extracranial Metastases

Abstract Background The objectives of this study were to characterize (1) epidemiology of brain metastases at the time of primary cancer diagnosis, (2) incidence and trends of synchronous brain metastases from 2010 to 2015, and (3) overall survival (OS) of patients with synchronous brain metastases. Methods A total of 42 047 patients with synchronous brain metastases from 2010 to 2015 were identified from the Surveillance, Epidemiology, and End Results database. Descriptive analysis was utilized to analyze demographics and incidence. The Kaplan–Meier method and a Cox proportional hazards model were utilized to evaluate potential prognostic factors for OS. Results The majority of patients were diagnosed from age older than 50 (91.9%). Common primary sites included lung (80%), melanoma (3.8%), breast (3.7%), and kidney/renal pelvis (3.0%). Among pediatric patients, common primaries included kidney/renal pelvis and melanomas. The incidence was roughly 7.3 persons/100 000. Synchronous brain metastases were associated with significantly poorer OS compared to extracranial metastases alone (hazard ratio [HR] =1.56; 95% CI: 1.54–1.58; P &lt; .001). Among patients with brain metastases, male gender (HR = 1.60 vs 1.52), age older than 65 years (HR = 1.60 vs 1.46), synchronous liver, bone, or lung metastases (HR = 1.61 vs 1.49), and earlier year of diagnosis (HR = 0.98 for each year following 2010) were associated with significantly poorer OS. Conclusions The vast majority of brain metastases are from lung primaries. Synchronous brain metastases are associated with poorer OS compared to extracranial metastases alone.

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]

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