• Ishwaria M Subbiah, Xiudong Lei, Jeffrey S Weinberg, Erik P Sulman, Mariana Chavez-MacGregor, Debu Tripathy, Rohan Gupta, Ankur Varma, Jay Chouhan, Richard P Guevarra, Vicente Valero, Mark R Gilbert, and Ana M Gonzalez-Angulo.
• All authors: University of Texas MD Anderson Cancer Center, Houston, TX.
• J. Clin. Oncol. 2015 Jul 10; 33 (20): 2239-45.

PurposeSeveral indices have been developed to predict overall survival (OS) in patients with breast cancer with brain metastases, including the breast graded prognostic assessment (breast-GPA), comprising age, tumor subtype, and Karnofsky performance score. However, number of brain metastases-a highly relevant clinical variable-is less often incorporated into the final model. We sought to validate the existing breast-GPA in an independent larger cohort and refine it integrating number of brain metastases.Patients And MethodsData were retrospectively gathered from a prospectively maintained institutional database. Patients with newly diagnosed brain metastases from 1996 to 2013 were identified. After validating the breast-GPA, multivariable Cox regression and recursive partitioning analysis led to the development of the modified breast-GPA. The performances of the breast-GPA and modified breast-GPA were compared using the concordance index.ResultsIn our cohort of 1,552 patients, the breast-GPA was validated as a prognostic tool for OS (P < .001). In multivariable analysis of the breast-GPA and number of brain metastases (> three v ≤ three), both were independent predictors of OS. We therefore developed the modified breast-GPA integrating a fourth clinical parameter. Recursive partitioning analysis reinforced the prognostic significance of these four factors. Concordance indices were 0.78 (95% CI, 0.77 to 0.80) and 0.84 (95% CI, 0.83 to 0.85) for the breast-GPA and modified breast-GPA, respectively (P < .001).ConclusionThe modified breast-GPA incorporates four simple clinical parameters of high prognostic significance. This index has an immediate role in the clinic as a formative part of the clinician's discussion of prognosis and direction of care and as a potential patient selection tool for clinical trials.© 2015 by American Society of Clinical Oncology.

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