TY - JOUR
T1 - Nomogram to predict subsequent brain metastasis in patients with metastatic breast cancer
AU - Graesslin, Olivier
AU - Abdulkarim, Bassam S.
AU - Coutant, Charles
AU - Huguet, Florence
AU - Gabos, Zsolt
AU - Hsu, Limin
AU - Marpeau, Olivier
AU - Uzan, Serge
AU - Pusztai, Lajos
AU - Strom, Eric A.
AU - Hortobagyi, Gabriel N.
AU - Rouzier, Roman
AU - Ibrahim, Nuhad K.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2010/4/20
Y1 - 2010/4/20
N2 - Purpose: Brain metastasis is usually a fatal event in patients with stage IV breast cancer. We hypothesized that its occurrence can be predicted if a clinical nomogram can be developed, thus allowing for selection of enriched patient populations for prevention trials. Patients and Methods: Electronic medical records of patients with metastatic breast cancer were retrospectively reviewed for the period between January 2000 and February 2007 under a study approved by the institutional review board. A multivariate logistic regression analysis of selected prognostic features was done. A nomogram to predict brain metastasis was constructed and validated in a cohort of 128 patients with brain metastasis treated at the Cross Cancer Institute (Edmonton, Alberta, Canada). Results: Of 2,136 patients with breast cancer, 362 developed subsequent brain metastasis. Age, grade, negative status of estrogen receptor and human epidermal growth factor receptor 2, number of metastatic sites (one v > one), and short disease-free survival were significantly and independently associated with subsequent brain metastasis. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.68 (95% CI, 0.66 to 0.69) in the training set. The validation set showed a good discrimination with an AUC of 0.74 (95% CI, 0.70 to 0.79). The nomogram was well calibrated, with no significant difference between the predicted and the observed probabilities. Conclusion: We have developed a robust tool that is able to predict subsequent brain metastasis in patients with breast cancer with nonbrain metastatic disease. Selection of an enriched patient population at high risk for brain metastasis will facilitate the design of trials aiming at its prevention.
AB - Purpose: Brain metastasis is usually a fatal event in patients with stage IV breast cancer. We hypothesized that its occurrence can be predicted if a clinical nomogram can be developed, thus allowing for selection of enriched patient populations for prevention trials. Patients and Methods: Electronic medical records of patients with metastatic breast cancer were retrospectively reviewed for the period between January 2000 and February 2007 under a study approved by the institutional review board. A multivariate logistic regression analysis of selected prognostic features was done. A nomogram to predict brain metastasis was constructed and validated in a cohort of 128 patients with brain metastasis treated at the Cross Cancer Institute (Edmonton, Alberta, Canada). Results: Of 2,136 patients with breast cancer, 362 developed subsequent brain metastasis. Age, grade, negative status of estrogen receptor and human epidermal growth factor receptor 2, number of metastatic sites (one v > one), and short disease-free survival were significantly and independently associated with subsequent brain metastasis. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.68 (95% CI, 0.66 to 0.69) in the training set. The validation set showed a good discrimination with an AUC of 0.74 (95% CI, 0.70 to 0.79). The nomogram was well calibrated, with no significant difference between the predicted and the observed probabilities. Conclusion: We have developed a robust tool that is able to predict subsequent brain metastasis in patients with breast cancer with nonbrain metastatic disease. Selection of an enriched patient population at high risk for brain metastasis will facilitate the design of trials aiming at its prevention.
UR - http://www.scopus.com/inward/record.url?scp=77951647270&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951647270&partnerID=8YFLogxK
U2 - 10.1200/JCO.2009.24.6314
DO - 10.1200/JCO.2009.24.6314
M3 - Article
C2 - 20308667
AN - SCOPUS:77951647270
SN - 0732-183X
VL - 28
SP - 2032
EP - 2037
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -