Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases
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 40...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2012-04, Vol.82 (5), p.2111-2117 |
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| creator | Sperduto, Paul W., M.D., M.P.P Kased, Norbert, M.D Roberge, David, M.D Xu, Zhiyuan, M.D Shanley, Ryan, M.S Luo, Xianghua, Ph.D Sneed, Penny K., M.D Chao, Samuel T., M.D Weil, Robert J., M.D Suh, John, M.D Bhatt, Amit, M.D Jensen, Ashley W., M.D Brown, Paul D., M.D Shih, Helen A., M.D Kirkpatrick, John, M.D., Ph.D Gaspar, Laurie E., M.D., FASTRO Fiveash, John B., M.D Chiang, Veronica, M.D Knisely, Jonathan P.S., M.D Sperduto, Christina Maria Lin, Nancy, M.D Mehta, Minesh, M.D., FASTRO |
| description | 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. |
| doi_str_mv | 10.1016/j.ijrobp.2011.02.027 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3172400</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0360301611003282</els_id><sourcerecordid>1238114970</sourcerecordid><originalsourceid>FETCH-LOGICAL-c608t-b6898029f2957dc66555f3451270fca646a4ea6bba7cefc468ac276362555dc3</originalsourceid><addsrcrecordid>eNqFUl1rFDEUHUSxa_UfiARE9GXXJDOTzLwU2qVWoWKhC_oWMpk73ayzyZpkFvah_713umv9eFAIJCTnnHtuzs2yl4zOGGXi_WpmV8E3mxmnjM0oxyUfZRNWyXqal-W3x9mE5oJOcwQfZc9iXFGKSFk8zY44K2pZlGyS3Z53HZhEfEcWw9oHcj00abcB4h0ew9ZudU-0a0laArkIuoWWXAV_43xM1pDTGCHGNbhEOiRf6WTxHMlXm5bkLICOicy1MxDuRc6Cto58hoT3GpnPsyed7iO8OOzH2eLD-WL-cXr55eLT_PRyagSt0rQRVV1RXne8LmVrhCjLssvRP5e0M1oUQhegRdNoaaAzhai04VLkgiOwNflxdrKX3QzNGlqDFoPu1SbYtQ475bVVf744u1Q3fqtyJnlBKQq83guMXatobAKzNN45_DrFOS0FrwpEvT2UCf7HADGptY0G-l478ENUNdqnVZnniHz3TyTjecXGjMbSxR5qgo8xQPdgm1E1DoJaqf0gqHEQFOW4JNJe_d7yA-ln8gh4cwDoaHTfBUzJxl-4UoqqvG_98HeA-WwthLF9wERbG8buW2__5-RvAdNbZ7Hmd9hBXPkhOMxeMRWRoK7HoR1nljGsziue3wEn4ei3</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1238114970</pqid></control><display><type>article</type><title>Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Sperduto, Paul W., M.D., M.P.P ; Kased, Norbert, M.D ; Roberge, David, M.D ; Xu, Zhiyuan, M.D ; Shanley, Ryan, M.S ; Luo, Xianghua, Ph.D ; Sneed, Penny K., M.D ; Chao, Samuel T., M.D ; Weil, Robert J., M.D ; Suh, John, M.D ; Bhatt, Amit, M.D ; Jensen, Ashley W., M.D ; Brown, Paul D., M.D ; Shih, Helen A., M.D ; Kirkpatrick, John, M.D., Ph.D ; Gaspar, Laurie E., M.D., FASTRO ; Fiveash, John B., M.D ; Chiang, Veronica, M.D ; Knisely, Jonathan P.S., M.D ; Sperduto, Christina Maria ; Lin, Nancy, M.D ; Mehta, Minesh, M.D., FASTRO</creator><creatorcontrib>Sperduto, Paul W., M.D., M.P.P ; Kased, Norbert, M.D ; Roberge, David, M.D ; Xu, Zhiyuan, M.D ; Shanley, Ryan, M.S ; Luo, Xianghua, Ph.D ; Sneed, Penny K., M.D ; Chao, Samuel T., M.D ; Weil, Robert J., M.D ; Suh, John, M.D ; Bhatt, Amit, M.D ; Jensen, Ashley W., M.D ; Brown, Paul D., M.D ; Shih, Helen A., M.D ; Kirkpatrick, John, M.D., Ph.D ; Gaspar, Laurie E., M.D., FASTRO ; Fiveash, John B., M.D ; Chiang, Veronica, M.D ; Knisely, Jonathan P.S., M.D ; Sperduto, Christina Maria ; Lin, Nancy, M.D ; Mehta, Minesh, M.D., FASTRO</creatorcontrib><description>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.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2011.02.027</identifier><identifier>PMID: 21497451</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Age ; Age Factors ; Aged ; Aged, 80 and over ; Biological and medical sciences ; BRAIN ; Brain metastases ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - secondary ; Breast cancer ; Breast Neoplasms - metabolism ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Breast Neoplasms, Male - metabolism ; Breast Neoplasms, Male - mortality ; Breast Neoplasms, Male - pathology ; CLINICAL TRIALS ; Cohort Studies ; Data processing ; DECISION MAKING ; DIAGNOSIS ; ErbB-2 protein ; Estrogen ; ESTROGENS ; Female ; Gynecology. Andrology. Obstetrics ; Hematology, Oncology and Palliative Medicine ; HER2 ; Humans ; Karnofsky Performance Status ; Male ; Mammary gland diseases ; MAMMARY GLANDS ; Medical sciences ; METASTASES ; Middle Aged ; MULTIVARIATE ANALYSIS ; NEOPLASMS ; Neurology ; Outcomes ; PATIENTS ; PROGESTERONE ; Prognosis ; Proportional Hazards Models ; Radiation therapy ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Receptor, ErbB-2 - metabolism ; Receptors, Estrogen - metabolism ; Receptors, Progesterone - metabolism ; Retrospective Studies ; Stereotactic radiosurgery ; SURGERY ; Survival ; SURVIVAL TIME ; Tumors ; Tumors of the nervous system. Phacomatoses</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-04, Vol.82 (5), p.2111-2117</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><rights>2011 Elsevier Inc. All rights reserved. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c608t-b6898029f2957dc66555f3451270fca646a4ea6bba7cefc468ac276362555dc3</citedby><cites>FETCH-LOGICAL-c608t-b6898029f2957dc66555f3451270fca646a4ea6bba7cefc468ac276362555dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301611003282$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25768500$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21497451$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22056284$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Sperduto, Paul W., M.D., M.P.P</creatorcontrib><creatorcontrib>Kased, Norbert, M.D</creatorcontrib><creatorcontrib>Roberge, David, M.D</creatorcontrib><creatorcontrib>Xu, Zhiyuan, M.D</creatorcontrib><creatorcontrib>Shanley, Ryan, M.S</creatorcontrib><creatorcontrib>Luo, Xianghua, Ph.D</creatorcontrib><creatorcontrib>Sneed, Penny K., M.D</creatorcontrib><creatorcontrib>Chao, Samuel T., M.D</creatorcontrib><creatorcontrib>Weil, Robert J., M.D</creatorcontrib><creatorcontrib>Suh, John, M.D</creatorcontrib><creatorcontrib>Bhatt, Amit, M.D</creatorcontrib><creatorcontrib>Jensen, Ashley W., M.D</creatorcontrib><creatorcontrib>Brown, Paul D., M.D</creatorcontrib><creatorcontrib>Shih, Helen A., M.D</creatorcontrib><creatorcontrib>Kirkpatrick, John, M.D., Ph.D</creatorcontrib><creatorcontrib>Gaspar, Laurie E., M.D., FASTRO</creatorcontrib><creatorcontrib>Fiveash, John B., M.D</creatorcontrib><creatorcontrib>Chiang, Veronica, M.D</creatorcontrib><creatorcontrib>Knisely, Jonathan P.S., M.D</creatorcontrib><creatorcontrib>Sperduto, Christina Maria</creatorcontrib><creatorcontrib>Lin, Nancy, M.D</creatorcontrib><creatorcontrib>Mehta, Minesh, M.D., FASTRO</creatorcontrib><title>Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>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.</description><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>BRAIN</subject><subject>Brain metastases</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - secondary</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - metabolism</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms, Male - metabolism</subject><subject>Breast Neoplasms, Male - mortality</subject><subject>Breast Neoplasms, Male - pathology</subject><subject>CLINICAL TRIALS</subject><subject>Cohort Studies</subject><subject>Data processing</subject><subject>DECISION MAKING</subject><subject>DIAGNOSIS</subject><subject>ErbB-2 protein</subject><subject>Estrogen</subject><subject>ESTROGENS</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>HER2</subject><subject>Humans</subject><subject>Karnofsky Performance Status</subject><subject>Male</subject><subject>Mammary gland diseases</subject><subject>MAMMARY GLANDS</subject><subject>Medical sciences</subject><subject>METASTASES</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>NEOPLASMS</subject><subject>Neurology</subject><subject>Outcomes</subject><subject>PATIENTS</subject><subject>PROGESTERONE</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiation therapy</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Receptor, ErbB-2 - metabolism</subject><subject>Receptors, Estrogen - metabolism</subject><subject>Receptors, Progesterone - metabolism</subject><subject>Retrospective Studies</subject><subject>Stereotactic radiosurgery</subject><subject>SURGERY</subject><subject>Survival</subject><subject>SURVIVAL TIME</subject><subject>Tumors</subject><subject>Tumors of the nervous system. Phacomatoses</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUl1rFDEUHUSxa_UfiARE9GXXJDOTzLwU2qVWoWKhC_oWMpk73ayzyZpkFvah_713umv9eFAIJCTnnHtuzs2yl4zOGGXi_WpmV8E3mxmnjM0oxyUfZRNWyXqal-W3x9mE5oJOcwQfZc9iXFGKSFk8zY44K2pZlGyS3Z53HZhEfEcWw9oHcj00abcB4h0ew9ZudU-0a0laArkIuoWWXAV_43xM1pDTGCHGNbhEOiRf6WTxHMlXm5bkLICOicy1MxDuRc6Cto58hoT3GpnPsyed7iO8OOzH2eLD-WL-cXr55eLT_PRyagSt0rQRVV1RXne8LmVrhCjLssvRP5e0M1oUQhegRdNoaaAzhai04VLkgiOwNflxdrKX3QzNGlqDFoPu1SbYtQ475bVVf744u1Q3fqtyJnlBKQq83guMXatobAKzNN45_DrFOS0FrwpEvT2UCf7HADGptY0G-l478ENUNdqnVZnniHz3TyTjecXGjMbSxR5qgo8xQPdgm1E1DoJaqf0gqHEQFOW4JNJe_d7yA-ln8gh4cwDoaHTfBUzJxl-4UoqqvG_98HeA-WwthLF9wERbG8buW2__5-RvAdNbZ7Hmd9hBXPkhOMxeMRWRoK7HoR1nljGsziue3wEn4ei3</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Sperduto, Paul W., M.D., M.P.P</creator><creator>Kased, Norbert, M.D</creator><creator>Roberge, David, M.D</creator><creator>Xu, Zhiyuan, M.D</creator><creator>Shanley, Ryan, M.S</creator><creator>Luo, Xianghua, Ph.D</creator><creator>Sneed, Penny K., M.D</creator><creator>Chao, Samuel T., M.D</creator><creator>Weil, Robert J., M.D</creator><creator>Suh, John, M.D</creator><creator>Bhatt, Amit, M.D</creator><creator>Jensen, Ashley W., M.D</creator><creator>Brown, Paul D., M.D</creator><creator>Shih, Helen A., M.D</creator><creator>Kirkpatrick, John, M.D., Ph.D</creator><creator>Gaspar, Laurie E., M.D., FASTRO</creator><creator>Fiveash, John B., M.D</creator><creator>Chiang, Veronica, M.D</creator><creator>Knisely, Jonathan P.S., M.D</creator><creator>Sperduto, Christina Maria</creator><creator>Lin, Nancy, M.D</creator><creator>Mehta, Minesh, M.D., FASTRO</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><scope>OTOTI</scope><scope>5PM</scope></search><sort><creationdate>20120401</creationdate><title>Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases</title><author>Sperduto, Paul W., M.D., M.P.P ; Kased, Norbert, M.D ; Roberge, David, M.D ; Xu, Zhiyuan, M.D ; Shanley, Ryan, M.S ; Luo, Xianghua, Ph.D ; Sneed, Penny K., M.D ; Chao, Samuel T., M.D ; Weil, Robert J., M.D ; Suh, John, M.D ; Bhatt, Amit, M.D ; Jensen, Ashley W., M.D ; Brown, Paul D., M.D ; Shih, Helen A., M.D ; Kirkpatrick, John, M.D., Ph.D ; Gaspar, Laurie E., M.D., FASTRO ; Fiveash, John B., M.D ; Chiang, Veronica, M.D ; Knisely, Jonathan P.S., M.D ; Sperduto, Christina Maria ; Lin, Nancy, M.D ; Mehta, Minesh, M.D., FASTRO</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c608t-b6898029f2957dc66555f3451270fca646a4ea6bba7cefc468ac276362555dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>BRAIN</topic><topic>Brain metastases</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - secondary</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - metabolism</topic><topic>Breast Neoplasms - mortality</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms, Male - metabolism</topic><topic>Breast Neoplasms, Male - mortality</topic><topic>Breast Neoplasms, Male - pathology</topic><topic>CLINICAL TRIALS</topic><topic>Cohort Studies</topic><topic>Data processing</topic><topic>DECISION MAKING</topic><topic>DIAGNOSIS</topic><topic>ErbB-2 protein</topic><topic>Estrogen</topic><topic>ESTROGENS</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>HER2</topic><topic>Humans</topic><topic>Karnofsky Performance Status</topic><topic>Male</topic><topic>Mammary gland diseases</topic><topic>MAMMARY GLANDS</topic><topic>Medical sciences</topic><topic>METASTASES</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>NEOPLASMS</topic><topic>Neurology</topic><topic>Outcomes</topic><topic>PATIENTS</topic><topic>PROGESTERONE</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiation therapy</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Receptor, ErbB-2 - metabolism</topic><topic>Receptors, Estrogen - metabolism</topic><topic>Receptors, Progesterone - metabolism</topic><topic>Retrospective Studies</topic><topic>Stereotactic radiosurgery</topic><topic>SURGERY</topic><topic>Survival</topic><topic>SURVIVAL TIME</topic><topic>Tumors</topic><topic>Tumors of the nervous system. Phacomatoses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sperduto, Paul W., M.D., M.P.P</creatorcontrib><creatorcontrib>Kased, Norbert, M.D</creatorcontrib><creatorcontrib>Roberge, David, M.D</creatorcontrib><creatorcontrib>Xu, Zhiyuan, M.D</creatorcontrib><creatorcontrib>Shanley, Ryan, M.S</creatorcontrib><creatorcontrib>Luo, Xianghua, Ph.D</creatorcontrib><creatorcontrib>Sneed, Penny K., M.D</creatorcontrib><creatorcontrib>Chao, Samuel T., M.D</creatorcontrib><creatorcontrib>Weil, Robert J., M.D</creatorcontrib><creatorcontrib>Suh, John, M.D</creatorcontrib><creatorcontrib>Bhatt, Amit, M.D</creatorcontrib><creatorcontrib>Jensen, Ashley W., M.D</creatorcontrib><creatorcontrib>Brown, Paul D., M.D</creatorcontrib><creatorcontrib>Shih, Helen A., M.D</creatorcontrib><creatorcontrib>Kirkpatrick, John, M.D., Ph.D</creatorcontrib><creatorcontrib>Gaspar, Laurie E., M.D., FASTRO</creatorcontrib><creatorcontrib>Fiveash, John B., M.D</creatorcontrib><creatorcontrib>Chiang, Veronica, M.D</creatorcontrib><creatorcontrib>Knisely, Jonathan P.S., M.D</creatorcontrib><creatorcontrib>Sperduto, Christina Maria</creatorcontrib><creatorcontrib>Lin, Nancy, M.D</creatorcontrib><creatorcontrib>Mehta, Minesh, M.D., FASTRO</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sperduto, Paul W., M.D., M.P.P</au><au>Kased, Norbert, M.D</au><au>Roberge, David, M.D</au><au>Xu, Zhiyuan, M.D</au><au>Shanley, Ryan, M.S</au><au>Luo, Xianghua, Ph.D</au><au>Sneed, Penny K., M.D</au><au>Chao, Samuel T., M.D</au><au>Weil, Robert J., M.D</au><au>Suh, John, M.D</au><au>Bhatt, Amit, M.D</au><au>Jensen, Ashley W., M.D</au><au>Brown, Paul D., M.D</au><au>Shih, Helen A., M.D</au><au>Kirkpatrick, John, M.D., Ph.D</au><au>Gaspar, Laurie E., M.D., FASTRO</au><au>Fiveash, John B., M.D</au><au>Chiang, Veronica, M.D</au><au>Knisely, Jonathan P.S., M.D</au><au>Sperduto, Christina Maria</au><au>Lin, Nancy, M.D</au><au>Mehta, Minesh, M.D., FASTRO</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>82</volume><issue>5</issue><spage>2111</spage><epage>2117</epage><pages>2111-2117</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21497451</pmid><doi>10.1016/j.ijrobp.2011.02.027</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0360-3016 |
| ispartof | International journal of radiation oncology, biology, physics, 2012-04, Vol.82 (5), p.2111-2117 |
| issn | 0360-3016 1879-355X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3172400 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Age Age Factors Aged Aged, 80 and over Biological and medical sciences BRAIN Brain metastases Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - secondary Breast cancer Breast Neoplasms - metabolism Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms, Male - metabolism Breast Neoplasms, Male - mortality Breast Neoplasms, Male - pathology CLINICAL TRIALS Cohort Studies Data processing DECISION MAKING DIAGNOSIS ErbB-2 protein Estrogen ESTROGENS Female Gynecology. Andrology. Obstetrics Hematology, Oncology and Palliative Medicine HER2 Humans Karnofsky Performance Status Male Mammary gland diseases MAMMARY GLANDS Medical sciences METASTASES Middle Aged MULTIVARIATE ANALYSIS NEOPLASMS Neurology Outcomes PATIENTS PROGESTERONE Prognosis Proportional Hazards Models Radiation therapy Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Receptor, ErbB-2 - metabolism Receptors, Estrogen - metabolism Receptors, Progesterone - metabolism Retrospective Studies Stereotactic radiosurgery SURGERY Survival SURVIVAL TIME Tumors Tumors of the nervous system. Phacomatoses |
| title | Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases |
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