Survival outcomes among patients with breast cancer and leptomeningeal disease
Bibliographic record
Abstract
Despite advances in metastatic breast cancer (MBC) management, leptomeningeal disease (LMD) prognosis remains poor. This study evaluates clinicopathological and treatment factors influencing outcomes of MBC patients with LMD treated with radiotherapy (RT). We conducted a retrospective analysis of patients with MBC treated with RT for brain metastases (BrM) between 2005 and 2019. LMD diagnosis was made via magnetic resonance imaging (MRI). Multivariable analysis (MVA) identified variables associated with brain-specific progression-free survival (bsPFS) and overall survival (OS). Among 691 MBC patients treated with RT for BrM, 161 (23%) had LMD, either at initial presentation (50/161) or after BrM treatment. Patients with LMD were younger, more likely to have ER + disease, more likely to have undergone surgery for BrM, and less likely to have received prior whole-brain RT. HER2+ LMD was associated with longer bsPFS (HR 0.47, 95% CI: 0.25-0.86, p = 0.01) and OS (HR 0.38, 95% CI: 0.2-0.75, p = 0.002). Median OS for triple-negative breast cancer was 3.7 months, 5.1 months for HR+/HER2 - and 15.4 months for HER2 + MBC. HER2-targeted therapy, either at or after LMD diagnosis, improved long-term survival (> 2 years) (Fisher's test, p < 0.05). Low Karnofsky Performance Status (KPS < 60) was linked to shorter bsPFS (HR 2.91, 95% CI: 1.49-5.69, p < 0.01) and OS (HR 3.37, 95% CI: 1.78-6.41, p < 0.001). These findings highlight the need for effective CNS-penetrating systemic therapies for HER2-negative breast cancer.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".