Real-world outcomes of breast cancer patients with brain metastases treated with radiotherapy in Ontario: A population-based study.
Notice bibliographique
Résumé
2027 Background: Brain Metastases (BrM) are a major cause of morbidity and mortality in patients with metastatic breast cancer (MBC). Real-word data regarding time to development of breast cancer BrM and survival outcomes is lacking. Methods: We conducted a retrospective, observational population-based cohort study to assess treatment patterns and outcomes of patients with de-novo MBC who received radiotherapy for intracranial metastatic disease between January 2009 and December 2018. We used population health administrative databases in Ontario held at ICES, an independent, non-profit research institute. Primary endpoints were i) cumulative incidence of radiotherapy for BrM accounting for the competing risk of death, and ii) time from MBC diagnosis to brain radiotherapy. Secondary endpoints included overall survival (OS) and radiation therapy toxicity. Data were censored if patients were alive on the same therapy at last available follow-up with the last cut-off date being March 31, 2019. Kaplan-Meier analyses were performed for the time to event endpoints and compared using the log-rank test. Cumulative incidence of radiotherapy for BrM from the diagnosis of MBC was calculated using the Cumulative Incidence Function (CIF), accounting for the competing risk of death using a competing risk analysis. Multivariable regression models were used to account for confounding variables. Results: 3,916 patients with de-novo MBC were identified, among whom 549 (14%) developed BrM requiring radiotherapy; cumulative incidence of BrM at 7-year follow-up was highest among patients with HER2+/HR- (34.7%) and HER2+/HR+ (28.1%) disease, followed by triple negative MBC (21.9%) and HR+/HER2- (12.1%) subtypes. The median time from diagnosis of MBC to first radiotherapy treatment for BrM was 7.5 months, 15.0 months, 16.8 months and 19.8 months, in TNBC, HER2+/HR-, HR+/HER2- and HER2+/HR+ subtypes, respectively. The median OS from radiotherapy among patients with breast cancer BrM was 5.1 months in the overall cohort. When analyzed by subtype, the median OS was 2.6 months, 4.8 months, 8.7 months, and 9.4 months in TNBC, HR+/HER2, HER2+/HR+ and HER2+/HR- subtypes, respectively. In a multivariable Cox regression model, a triple negative or HR+/HER2- breast cancer subtype, treatment with WBRT, age > 60 and a high-income quintile (4 or 5) were independently prognostic for shorter OS after adjustment for the index year at diagnosis. Patients treated with stereotactic radiosurgery (SRS) had lower 30-day mortality (6.4% vs. 18.9%, p = 0.003) and lower likelihood of hospitalization within 30 days of therapy (9.6% vs. 20.2%, p = 0.015) compared to patients treated with WBRT. Conclusions: Approximately 1 in 7 patients with MBC will require radiotherapy for BrM. Our data support the use of SRS when clinically indicated and provide insights regarding the time to development of BrM by breast cancer subtype.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».