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

SIMPLE SUMMARY: The aim of the present retrospective study was to develop a new scoring system for prognosis of patients undergoing surgery for breast cancer brain metastasis. Our institutional cohort (n = 95) was analyzed with regard to independent predictors of short (<6 months) and long (≥3 years) survival. Breast-preserving surgery, presence of multiple brain metastases, and age ≥ 65 years at brain cancer diagnosis were associated with short survival. In turn, positive HER2 receptor status in brain metastasis, time interval ≥ 3 years between breast cancer and brain metastasis diagnosis and KPS ≥ 90% were the long survival predictors. The scores based on the above-mentioned independent predictors showed good diagnostic accuracy for the prediction of short (AUC = 0.773) and long (AUC = 0.775) survival. After external validation, the presented scores might become useful tools to support the interdisciplinary decision for the selection of treatment strategy in individuals with 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.