Carsten Nieder, Oddvar Spanne, Ingvild Bilberg and Astrid Dalhaug
Background: Recursive partitioning analysis classes is the prognostic score that has been found by several groups to predict survival in patients with brain metastases from primary breast cancer. Recent data suggests that primary tumour characteristics might provide further important information. Methods: The impact of primary tumour size, histological grade, hormone receptor status, number of lymph node metastases and Nottingham prognostic index (NPI) was evaluated together with established factors such as performance status by uni- and multivariate analyses in 90 patients. All patients had been treated with whole-brain radiotherapy with or without radiosurgery or surgical resection. Results: In multivariate analysis, only performance status, age and interval from primary tumour diagnosis to brain metastases were significant. Patients with favourable NPI survived longer. However, this finding is based on a small group of patients and needs to be confirmed in larger studies. Higher histological grade and NPI were associated with significantly shorter interval to development of brain metastases. Conclusions: The standard brain metastases scores might not fully appreciate the unique biology and time course of breast cancer. Emerging prognostic factors such as NPI or triple-negative status might improve the models currently used by clinicians.
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