Activity of extracranial metastases as a prognostic factor influencing survival after radiosurgery of brain metastases

Jeremić, Branislav; Becker, Gerd; Plaßwilm, Ludwig; Bamberg, M.

doi:10.1007/s004320000126

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…Extracranial metastases as a prognostic predictor have been reviewed previously. Regardless of the Recursive Partitioning Analysis (RPA) or the DS-GPA index or any other prognostic index, ECM has always been an independent prognosticator influencing survival and is most often the strongest one14-17. In our study, ECM was once again confirmed to be prognostic.…”

Section: Discussionsupporting

confidence: 57%

Real-World Data on Prognostic Factors for Overall Survival in EGFR-Mutant Non-Small-Cell Lung Cancer Patients with Brain Metastases

Fan

2019

J. Cancer

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Background : With the wide application of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), the survival of EGFR-mutant non-small-cell lung cancer (NSCLC) patients with brain metastasis (BM) has been significantly improved. However, prognosis analysis for patients with EGFR mutation and BM is still lacking, and the prognostic factors remain to be determined. Materials and methods : A total of 746 NSCLC patients with BM were identified between January 2013 and December 2016 at our institution. Overall, 261 patients harboring EGFR mutation and meeting the inclusion criteria for the study were enrolled. Exclusion criteria included KPS<50, diagnosed with BM during treatment with EGFR-TKIs, or insufficient follow-up. Overall survival (OS) was measured from the date of brain metastases. Independent prognostic factors were confirmed using a Cox regression model. Results : The median follow-up time for these patients was 32.7 months (95% CI, 23.5-41.9). The median OS after development of brain metastases was 23.0 months (95% CI, 20.01-25.99). By univariate analysis, significantly shorter OS was noted in patients older than 65 years (p=0.025), KPS <70 (p=0.003), presence of extracranial metastases (ECM) (p=0.00), without intracranial local treatment (p=0.000), and without chemotherapy (p=0.001). There was no difference in OS with respect to EGFR mutation type and number of BM (p=0.343, p=0.729, respectively). The Cox proportional hazards regression model revealed that performance status (KPS<70, p=0.010), ECM (p=0.001), receiving intracranial local treatment (p=0.005) and chemotherapy (p=0.005) were independent prognostic factors for OS, while age was not (p=0.087). Patients with higher diagnosis-specific graded prognostic assessment (DS-GPA) and Lung-molGPA scores corresponded to better prognosis (p=0.000). Conclusion : This retrospective analysis demonstrated that performance status (KPS≥70), absence of ECM metastases, administration of local treatment and chemotherapy were associated with superior OS in patients with EGFR-mutant NSCLC who developed BM. The DS-GPA and Lung-molGPA indexes still applied to NSCLC patients with mutant genotypes and BM.

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Section: Discussionsupporting

confidence: 57%

Real-World Data on Prognostic Factors for Overall Survival in EGFR-Mutant Non-Small-Cell Lung Cancer Patients with Brain Metastases

Fan

2019

J. Cancer

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“…To prolong the survival of those patients, a vital factor that should be carefully considered and managed is the concurrence of extracranial metastasis and its activity. The presence of extracranial metastasis is known as an independent prognostic factor for the survival of patients with brain metastases [10][11][12][13]. In addition, the number of extracranial metastatic sites is negatively correlated with survival [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Extracranial metastatic patterns on occurrence of brain metastases

Vuong

Rades

et al. 2011

J Neurooncol

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Extracranial metastases and their frequency by sites have been described as prognostic factors for survival of patients with brain metastasis. However, these factors must be identified and described in more detail for a large series of patients. Using routine data from the largest German health insurance fund, 5,074 patients with brain metastasis who were diagnosed and treated in 2008 were analyzed to identify the frequency and distribution of extracranial metastatic sites concurrent with brain metastasis in relation to age, gender, and tumor type. Brain metastases were observed in males more frequently than in females (56.4 and 43.6% respectively P < 0.001), and were most often from lung (51.2%), breast (12.3%), and unknown (7.5%) primaries. Extracranial metastatic sites were observed in 58.8% of patients; the number of sites was from 1 to 7, with a mean of 1.11. For the 16 most common primary sites the range was from 0.13 to 1.91 . In 11 of these 16 sites, lungs were the most common concurrent metastatic site. Lung cancer, breast cancer, non-Hodgkin's lymphoma, and testicular cancer most commonly metastasized to bone, and bladder cancer to kidneys. Different primary tumors have different frequencies and patterns of extracranial metastatic sites concurrently with brain metastasis. The lung is the most common metastatic site of most primary tumors, bone for a few tumors, and kidneys for bladder cancer. For the unknown primary tumor type, screening for these most common metastatic sites must be intensified, in particular when molecular assessment is not available.

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Metastases to the Central Nervous System

2002

TxNxM1

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Activity of extracranial metastases as a prognostic factor influencing survival after radiosurgery of brain metastases

Cited by 8 publications

References 30 publications

Real-World Data on Prognostic Factors for Overall Survival in EGFR-Mutant Non-Small-Cell Lung Cancer Patients with Brain Metastases

Real-World Data on Prognostic Factors for Overall Survival in EGFR-Mutant Non-Small-Cell Lung Cancer Patients with Brain Metastases

Extracranial metastatic patterns on occurrence of brain metastases

Metastases to the Central Nervous System

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