Prediction of Short and Long Survival after Surgery for Breast Cancer Brain Metastases

Abstract

Background: Brain metastases requiring surgical treatment determine the prognosis of patients with breast cancer. We aimed to develop the scores for the prediction of short (<6 months) and long (≥3 years) survival after BCBM surgery. Methods: Female patients with BCBM surgery between 2008 and 2019 were included. The new scores were constructed upon independent predictors for short and long postoperative survival. Results: In the final cohort (n = 95), 18 (18.9%) and 22 (23.2%) patients experienced short and long postoperative survival, respectively. Breast-preserving surgery, presence of multiple brain metastases and age ≥ 65 years at breast cancer diagnosis were identified as independent predictors of short postoperative survival. In turn, positive HER2 receptor status in brain metastases, time interval ≥ 3 years between breast cancer and brain metastases diagnosis and KPS ≥ 90% independently predicted long survival. The appropriate short and long survival scores showed higher diagnostic accuracy for the prediction of short (AUC = 0.773) and long (AUC = 0.775) survival than the breast Graded Prognostic Assessment score (AUC = 0.498/0.615). A cumulative survival score (total score) showed significant association with overall survival (p = 0.001). Conclusion: We identified predictors independently impacting the prognosis after BCBM surgery. After external validation, the presented scores might become useful tools for the selection of proper candidates for BCBM surgery.

Keywords: HER2; brain metastasis; breast cancer; score.

Figure 1

Bar charts showing the association between the SS- (A)/LS- (B) scores and the survival rates at appropriate timepoints (6 months and 3 years for the SS- and LS-scores, respectively). The outcomes were reported for each score after the dichotomization into low (0–1 points) and high (2–3 points) score values.

Figure 2

Kaplan–Meier curves demonstrate the survival differences in BCBM patients with low (0-1 points) and high (2–3 points) score value: (A) SS-scores (log rank test p = 0.002). (B) LS-scores (log rank test p < 0.001).

Figure 3

The receiver operating characteristic curves (ROC) demonstrate the diagnostic accuracy of different scores with regard to the prediction of short survival (A) and long survival (B) in BCBM patients. (A): demonstrated the SS-score and different GPA scores (inversed) for short survival (6 months survival). (B): demonstrated the LS-score and different GPA scores for long survival (3 years survival). Abbreviations: LS: long survival, SS: short survival, GPA: Graded Prognostic Assessment, ob: original breast, mb: modified breast, ub: updated breast, AUC: areas under the curve.

Figure 4

Kaplan-Meier curve for the association between the Total-score and overall survival (log-rank test p = 0.001). According to the Total-score value, the survival curves were divided into three subgroups: “−3 to −1 points”. “0 to 1 point”. “2 to 3 points”.