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Open Access Research article

Comparative performances of prognostic indexes for breast cancer patients presenting with brain metastases

Antoine-Laurent Braccini1*, David Azria1, Simon Thezenas2, Gilles Romieu3, Jean-Marc Ferrero4 and William Jacot3

Author Affiliations

1 Department of Radiation Oncology, Val d’Aurelle Cancer Institute, 208 rue des apothicaires, Montpellier 34298, France

2 Department of Biostatistics, Val d’Aurelle Cancer Institute, 208 rue des apothicaires, 34298, Montpellier, France

3 Department of Medical Oncology, Val d’Aurelle Cancer Institute, 208 rue des apothicaires, 34298, Montpellier, France

4 Department of Medical Oncology, Antoine Lacassagne Cancer Institute, 33, avenue de Valombrose, 06189, Nice Cedex 02, France

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BMC Cancer 2013, 13:70  doi:10.1186/1471-2407-13-70

Published: 8 February 2013

Abstract

Background

Several prognostic indexes (PI) have been developed in the brain metastases (BM) setting to help physicians tailor treatment options and stratify patients enrolled in clinical studies. The aim of our study was to compare the clinical relevance of the major PI for breast cancer BM.

Methods

Clinical and biological data of 250 breast cancer patients diagnosed with BM at two institutions between 1995 and 2010 were retrospectively reviewed. The prognostic value and accuracy of recursive partitioning analysis (RPA), graded prognostic assessment (GPA), basic score for BM (BS-BM), breast RPA, breast GPA, Le Scodan’s Score and a clinico-biological score developed in a phase I study (P1PS) were assessed using Cox regression models. PI comparison was performed using Harrell’s concordance index.

Results

After a median follow-up of 4.5 years, median overall survival (OS) from BM diagnosis was 8.9 months (CI 95%, 6.9–10.3 months). All PI were significantly associated with OS. Harrell’s concordance indexes C favored BS-BM and RPA. In multivariate analysis, the RPA, Le Scodan’s score and GPA were found to be the best independent predictors of OS. In multivariate analysis restricted to the 159 patients with known LDH and proteinemia, RPA 2 and 3, Le Scodan’s Score 3 and P1PS 2/3 were associated with worse survival. RPA was the most accurate score to identify patients with long (superior to 12 months) and short (inferior to 3 months) life expectancy.

Conclusions

RPA seems to be the most useful score and performs better than new PI for breast cancer BM.

Keywords:
Breast cancer; Brain metastases; Prognostic indexes; Biological subtype