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Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16-12)

Authors
 Jae Sik Kim  ;  Kyubo Kim  ;  Wonguen Jung  ;  Kyung Hwan Shin  ;  Seock-Ah Im  ;  Hee-Jun Kim  ;  Yong Bae Kim  ;  Jee Suk Chang  ;  Doo Ho Choi  ;  Yeon Hee Park  ;  Dae Yong Kim  ;  Tae Hyun Kim  ;  Byung Ock Choi  ;  Sea-Won Lee  ;  Suzy Kim  ;  Jeanny Kwon  ;  Ki Mun Kang  ;  Woong-Ki Chung  ;  Kyung Su Kim  ;  Ji Ho Nam  ;  Won Sup Yoon  ;  Jin Hee Kim  ;  Jihye Cha  ;  Yoon Kyeong Oh  ;  In Ah Kim 
Citation
 BREAST, Vol.49 : 41-47, 2020-02 
Journal Title
 BREAST 
ISSN
 0960-9776 
Issue Date
2020-02
Keywords
Brain metastasis ; Breast cancer ; Overall survival ; Prognostic model ; Whole brain radiotherapy
Abstract
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 β-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.
Files in This Item:
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DOI
10.1016/j.breast.2019.10.007
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180195
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