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

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 NamWon Sup Yoon, Jin Hee Kim, Jihye Cha, Yoon Kyeong Oh, In Ah Kim

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)41-47
Number of pages7
JournalBreast
Volume49
DOIs
StatePublished - Feb 2020

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Korea
Multicenter Studies
Retrospective Studies
Breast Neoplasms
Neoplasm Metastasis
Survival
Brain
Radiotherapy
Propensity Score
Patient Selection
Medical Records
Multivariate Analysis
Hormones

Keywords

  • Brain metastasis
  • Breast cancer
  • Overall survival
  • Prognostic model
  • Whole brain radiotherapy

Cite this

Kim, Jae Sik ; Kim, Kyubo ; Jung, Wonguen ; Shin, Kyung Hwan ; Im, Seock Ah ; Kim, Hee Jun ; Kim, Yong Bae ; Chang, Jee Suk ; Choi, Doo Ho ; Park, Yeon Hee ; Kim, Dae Yong ; Kim, Tae Hyun ; Choi, Byung Ock ; Lee, Sea Won ; Kim, Suzy ; Kwon, Jeanny ; Kang, Ki Mun ; Chung, Woong Ki ; Kim, Kyung Su ; Nam, Ji Ho ; Yoon, Won Sup ; Kim, Jin Hee ; Cha, Jihye ; Oh, Yoon Kyeong ; Kim, In Ah. / Survival outcomes of breast cancer patients with brain metastases : A multicenter retrospective study in Korea (KROG 16–12). In: Breast. 2020 ; Vol. 49. pp. 41-47.
@article{56041aad6ae0433886bf4e30195dcdc5,
title = "Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16–12)",
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.",
keywords = "Brain metastasis, Breast cancer, Overall survival, Prognostic model, Whole brain radiotherapy",
author = "Kim, {Jae Sik} and Kyubo Kim and Wonguen Jung and Shin, {Kyung Hwan} and Im, {Seock Ah} and Kim, {Hee Jun} and Kim, {Yong Bae} and Chang, {Jee Suk} and Choi, {Doo Ho} and Park, {Yeon Hee} and Kim, {Dae Yong} and Kim, {Tae Hyun} and Choi, {Byung Ock} and Lee, {Sea Won} and Suzy Kim and Jeanny Kwon and Kang, {Ki Mun} and Chung, {Woong Ki} and Kim, {Kyung Su} and Nam, {Ji Ho} and Yoon, {Won Sup} and Kim, {Jin Hee} and Jihye Cha and Oh, {Yoon Kyeong} and Kim, {In Ah}",
year = "2020",
month = "2",
doi = "10.1016/j.breast.2019.10.007",
language = "English",
volume = "49",
pages = "41--47",
journal = "Breast",
issn = "0960-9776",
publisher = "Churchill Livingstone",

}

Kim, JS, Kim, K, Jung, W, Shin, KH, Im, SA, Kim, HJ, Kim, YB, Chang, JS, Choi, DH, Park, YH, Kim, DY, Kim, TH, Choi, BO, Lee, SW, Kim, S, Kwon, J, Kang, KM, Chung, WK, Kim, KS, Nam, JH, Yoon, WS, Kim, JH, Cha, J, Oh, YK & Kim, IA 2020, 'Survival outcomes of breast cancer patients with brain metastases: A multicenter retrospective study in Korea (KROG 16–12)', Breast, vol. 49, pp. 41-47. https://doi.org/10.1016/j.breast.2019.10.007

Survival outcomes of breast cancer patients with brain metastases : A multicenter retrospective study in Korea (KROG 16–12). / Kim, Jae Sik; Kim, Kyubo; Jung, Wonguen; Shin, Kyung Hwan; Im, Seock Ah; Kim, Hee Jun; Kim, Yong Bae; Chang, Jee Suk; Choi, Doo Ho; Park, Yeon Hee; Kim, Dae Yong; Kim, Tae Hyun; Choi, Byung Ock; Lee, Sea Won; Kim, Suzy; Kwon, Jeanny; Kang, Ki Mun; Chung, Woong Ki; Kim, Kyung Su; Nam, Ji Ho; Yoon, Won Sup; Kim, Jin Hee; Cha, Jihye; Oh, Yoon Kyeong; Kim, In Ah.

In: Breast, Vol. 49, 02.2020, p. 41-47.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival outcomes of breast cancer patients with brain metastases

T2 - A multicenter retrospective study in Korea (KROG 16–12)

AU - Kim, Jae Sik

AU - Kim, Kyubo

AU - Jung, Wonguen

AU - Shin, Kyung Hwan

AU - Im, Seock Ah

AU - Kim, Hee Jun

AU - Kim, Yong Bae

AU - Chang, Jee Suk

AU - Choi, Doo Ho

AU - Park, Yeon Hee

AU - Kim, Dae Yong

AU - Kim, Tae Hyun

AU - Choi, Byung Ock

AU - Lee, Sea Won

AU - Kim, Suzy

AU - Kwon, Jeanny

AU - Kang, Ki Mun

AU - Chung, Woong Ki

AU - Kim, Kyung Su

AU - Nam, Ji Ho

AU - Yoon, Won Sup

AU - Kim, Jin Hee

AU - Cha, Jihye

AU - Oh, Yoon Kyeong

AU - Kim, In Ah

PY - 2020/2

Y1 - 2020/2

N2 - 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.

AB - 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.

KW - Brain metastasis

KW - Breast cancer

KW - Overall survival

KW - Prognostic model

KW - Whole brain radiotherapy

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