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Brain Metastasis in Breast Cancer Patients—Need for Improvement
Article

Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry—Comparison of Three Different GPA Prognostic Scores

1
Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
2
Oncological Outpatient Department, Neversstraße 5, 56068 Koblenz, Germany
3
Department of Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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Department of Gynecology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Department of Hematology and Oncology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Clinic Bayreuth, Preuschwitzer Str. 101, 95445 Bayreuth, Germany
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Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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Department of Gynecology and Obstetrics, University Medical Center Ulm, Prittwitzstr. 43, 89075 Ulm, Germany
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Breast Center, Diakovere Henriettenstift, Schwemannstraße 17, 30559 Hannover, Germany
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Department of Gynecology, Agaplesion Diakonie Clinic Rotenburg, Elise-Averdieck-Straße 17, 27356 Rotenburg, Germany
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Department of Gynecology and gynecologic Oncology ,Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60341 Frankfurt am Main Frankfurt, Germany
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Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstraße 21-23, 91054 Erlangen, Germany
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Institute of Pathology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
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Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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German Breast Group, Martin-Behaim-Straße 12, 63263 Neu-Isenburg, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Simon S. Lo
Cancers 2021, 13(4), 844; https://doi.org/10.3390/cancers13040844
Received: 14 January 2021 / Revised: 8 February 2021 / Accepted: 12 February 2021 / Published: 17 February 2021
(This article belongs to the Special Issue Brain Metastasis in Breast Cancer)
The incidence of brain metastases from breast cancer is increasing and the treatment is still a major challenge. Several scores have been developed in order to estimate the prognosis of patients with brain metastases by objective criteria. Here, we validated all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer patients with brain metastases in the Brain Metastases in the German Breast Cancer (BMBC) registry. Although all three available GPA-scores were associated with OS, they all show limitations mainly in predicting short-term (below 3 months) survival but also in long-term (above 12 months) survival. We discuss the test performances of all scores in our work and provide evidence how physicians should use them as a tool to select patients for different treatment options.
Several scores have been developed in order to estimate the prognosis of patients with brain metastases (BM) by objective criteria. The aim of this analysis was to validate all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer (BC) patients with BM in the Brain Metastases in the German Breast Cancer (BMBC) registry. The median age at diagnosis of BM was 57 years. All in all, 22.3% of patients (n = 197) had triple-negative, 33.4% (n = 295) luminal A like, 25.1% (n = 221) luminal B/HER2-enriched like and 19.2% (n = 169) HER2 positive like BC. Age ≥60 years, evidence of extracranial metastases (ECM), higher number of BM, triple-negative subtype and low Karnofsky-Performance-Status (KPS) were all associated with worse overall survival (OS) in univariate analysis (p < 0.001 each). All three GPA-scores were associated with OS. The breast-GPA showed the highest probability of classifying patients with survival above 12 months in the best prognostic group (specificity 68.7% compared with 48.1% for the updated breast-GPA and 21.8% for the original GPA). Sensitivities for predicting 3 months survival were very low for all scores. In this analysis, all GPA-scores showed only moderate diagnostic accuracy in predicting the OS of BC patients with BM. View Full-Text
Keywords: brain metastases; breast cancer; prognostic scores brain metastases; breast cancer; prognostic scores
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MDPI and ACS Style

Riecke, K.; Müller, V.; Weide, R.; Schmidt, M.; Park-Simon, T.-W.; Möbus, V.; Mundhenke, C.; Polasik, A.; Lübbe, K.; Hesse, T.; Laakmann, E.; Thill, M.; A. Fasching, P.; Denkert, C.; Fehm, T.; Nekljudova, V.; Rey, J.; Loibl, S.; Witzel, I. Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry—Comparison of Three Different GPA Prognostic Scores. Cancers 2021, 13, 844. https://doi.org/10.3390/cancers13040844

AMA Style

Riecke K, Müller V, Weide R, Schmidt M, Park-Simon T-W, Möbus V, Mundhenke C, Polasik A, Lübbe K, Hesse T, Laakmann E, Thill M, A. Fasching P, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Witzel I. Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry—Comparison of Three Different GPA Prognostic Scores. Cancers. 2021; 13(4):844. https://doi.org/10.3390/cancers13040844

Chicago/Turabian Style

Riecke, Kerstin, Volkmar Müller, Rudolf Weide, Marcus Schmidt, Tjoung-Won Park-Simon, Volker Möbus, Christoph Mundhenke, Arkadius Polasik, Kristina Lübbe, Tobias Hesse, Elena Laakmann, Marc Thill, Peter A. Fasching, Carsten Denkert, Tanja Fehm, Valentina Nekljudova, Julia Rey, Sibylle Loibl, and Isabell Witzel. 2021. "Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry—Comparison of Three Different GPA Prognostic Scores" Cancers 13, no. 4: 844. https://doi.org/10.3390/cancers13040844

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