Puente et al reported a prognostic index for a woman with breast cancer that is metastatic at the time of recurrence. This can help to identify a woman who may benefit from the more aggressive or a novel therapy. The authors are from multiple institutions in Spain participating in the GEICAM El Alamo Register.
Patient selection: recurrent breast cancer, not metastatic (Stage IV) at diagnosis, now metastatic
Parameters:
(1) age at diagnosis in years (not stated if initial or recurrence, presume recurrence)
(2) clinical stage at initial diagnosis, from I to III
(3) ER and PR status
(4) histologic grade
(5) extracapsular extension in lymph nodes
(6) nodal ratio (number positive to total number)
(7) chemotherapy (neo and/or adjuvant)
(8) dominant site of metastasis
(9) number of recurrence sites
(10) surgery at recurrence
(11) radiotherapy at recurrence
(12) number of chemotherapy agents in metastatic disease
(13) number of hormonal therapy lines in metastatic disease
(14) response to the first line therapy (not stated to initial therapy or at recurrence but text on page 596 suggest at recurrence)
|
Parameter |
Finding |
Points |
|
age at diagnosis |
< 35 |
0 |
|
|
35 to 50 |
1.4 |
|
|
51 to 75 |
1.4 |
|
|
> 75 |
3 |
|
clinical stage |
I |
0 |
|
|
II |
1.5 |
|
|
III |
1.7 |
|
hormonal receptors |
ER and/or PR positive |
0 |
|
|
both ER and PR negative |
1.3 |
|
histologic grade |
well-differentiated (Grade I) |
0 |
|
|
moderately differentiated (Grade II) |
1.3 |
|
|
poorly differentiated (Grade III) |
1.6 |
|
extracapsular spread |
no |
0 |
|
|
yes |
1.2 |
|
nodal ratio |
< 0.25 |
0 |
|
|
0.25 to 0.75 |
1.3 |
|
|
> 0.75 |
1.4 |
|
chemotherapy |
no |
0 |
|
|
yes |
0.7 |
|
dominant site |
soft tissue |
0 |
|
|
bone |
2.8 |
|
|
lung |
3.9 |
|
|
visceral |
4.5 |
|
number of recurrence sites |
1 |
0 |
|
|
multiple |
1.3 |
|
surgery at recurrence |
no |
0 |
|
|
yes |
0.8 |
|
radiotherapy at recurrence |
no |
0 |
|
|
yes |
1.1 |
|
number of chemotherapy agents in metastatic disease |
0 |
1.3 |
|
|
1 |
1.4 |
|
|
2 |
1.2 |
|
|
>= 3 |
0 |
|
number of hormonal lines |
0 |
2.4 |
|
|
1 |
1.5 |
|
|
>= 2 |
0 |
|
response to first line therapy |
complete response |
0 |
|
|
partial response |
1.7 |
|
|
stable response |
1.7 |
|
|
stable disease |
1.9 |
|
|
progressive |
3.7 |
|
|
unknown |
2.2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 26
• The higher the score the worse the overall survival.
|
Total Score |
Risk Group |
Median Survival |
|
<= 13.5 |
good |
3.7 years |
|
13.51 to 15.60 |
intermediate |
2.3 years |
|
> 15.60 |
poor |
1 year |
Performance:
• The area under the ROC curve is 0.694.
Specialty: Hematology Oncology
