ArticleBreast (Edinburgh, Scotland)2026
Enhanced prognostic score for breast cancer brain metastases incorporating contemporary clinical features and leptomeningeal disease: Development and validation.
Article in Breast (Edinburgh, Scotland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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- Erratum issued
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11 authors.
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Abstract
purposePrognosis of breast cancer brain metastases (BCBM) remains heterogeneous. The current Breast-Graded Prognostic Assessment (GPA) lacks leptomeningeal disease (LMD) or contemporary clinical features. We aimed to develop and externally validate an enhanced prognostic scoring system integrating clinical factors, cancer subtypes, and LMD.
methodsIn this retrospective multi-institutional study, 207 patients with newly diagnosed BCBM treated with stereotactic radiosurgery between 2015 and 2021 formed the development cohort. 240 patients formed the external validation cohort. Clinical variables, GPA factors, and magnetic resonance imaging-based features including number of metastases, volumetric tumor burden, and LMD presence were analyzed. Univariable and multivariable Cox regression identified independent predictors for overall survival (OS). A weighted point-based scoring system (enhanced GPA, eGPA) was constructed and compared with the GPA using Harrell's C-index and time-dependent area under the curve.
resultsMedian OS in the development cohort was 13.9 months. Multivariable analysis identified Karnofsky performance status, breast cancer subtype, number of brain metastases, presence of extracranial metastasis, and LMD as independent prognostic factors (all P < .05). Total metastatic volume was not independently associated with OS. The eGPA demonstrated superior discrimination compared with GPA in the development cohort (C-index 0.64 vs. 0.60, P = .009) and comparable performance in the external validation cohort (0.65 vs. 0.66, P = .690). One-year AUC was higher for eGPA (0.71 vs. 0.65, P = .014). The inclusion of LMD provided meaningful risk stratification across subtypes.
conclusionAn enhanced GPA incorporating LMD and contemporary clinical factors improves risk assessment in BCBM and may better guide therapeutic decision-making prior to radiation therapy.
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