Applicability of the adjusted graded prognostic assessment for lung cancer with brain metastases using molecular markers (Lung‐molGPA) in a Chinese cohort: A retrospective study of multiple institutions

Abstract

Background In this era of precision medicine, prognostic heterogeneity is an important feature of patients with non‐small cell lung cancer (NSCLC) with brain metastases (BM). This multi‐institutional study is aimed to verify the applicability of the adjusted Lung‐molGPA model for NSCLC with BM in a Chinese cohort. Methods This retrospective study included 1903 patients at three hospitals in Southwest China. The performance of the Lung‐molGPA model was compared with that of the adjusted DS‐GPA model in terms of estimating the survival of NSCLC with BM. Results The median OS of this patient cohort was 27.0 months, and the adenocarcinoma survived longer than the non‐adenocarcinoma (28.0 months vs 18.7 months, p < 0.001). The adjusted Lung‐molGPA model was more accurate in predicting survival of adenocarcinoma patients than the adjusted DS‐GPA model (C‐index: 0.615 vs 0.571), and it was not suitable for predicting survival of non‐adenocarcinoma patients ( p = 0.286, 1.5‐2.0 vs 2.5‐3.0; p = 0.410, 2.5‐3.0 vs 3.5‐4.0). Conclusions The adjusted Lung‐molGPA model is better than the DS‐GPA model in predicting the prognosis of adenocarcinoma patients. However, it failed to estimate the prognosis for non‐adenocarcinoma patients.

Targeted Therapies and Utility of the Lung-molGPA in Non-Small-Cell Lung Cancer Patients with Brain Metastases

“…Although in the current study, the MSTs were shorter for all GPA groups than in the original work by Sperduto et al [15], they compare favorably with the MST estimates obtained by Nieder et al [16] in their independent validation of the Lung-molGPA. Conversely, other groups have reported longer MST for all prognostic classes of the Lung-molGPA [17][18][19][20]. Taken together, these studies show that the Lung-molGPA successfully classifies patients into groups with significantly different prognosis but that there is substantial variability in the MST reported between different institutions.…”

“…However, a limitation of the Lung-molGPA is that it provides group rather than individualized estimates of survival since the expected survival of each patient is based on the median survival for the prognostic group into which they are assigned [38]. As illustrated previously, the differences between studies in the MST estimates are clinically relevant [16][17][18][19][20]. Therefore, if the Lung-molGPA is to be used prospectively in clinical practice and research, we recommend for individual institutions to calculate the MST for each diagnosis and GPA group using data sets from their patient population, since it cannot be assumed that previously reported MST describe the population of patients to which the model will be applied.…”

“…To date, very few studies have validated the Lung-mol-GPA as described by Sperduto et al [15] in large and independent cohorts [16][17][18][19][20]. Furthermore, there have been conflicting reports regarding the effect of gene alterations and targeted therapies on the clinical and biological features of metastatic brain tumors from NSCLC [21][22][23][24][25].…”

Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

“…Therefore, the combination of craniocerebral radiotherapy and EGFR-TKIs should not be a one-size-fits-all model, and should instead be considered comprehensively to provide patients with the best individualized treatment plan. The formulation of craniocerebral radiotherapy strategies should be based on a comprehensive evaluation of the patient’s lung-molGPA score while making treatment decisions ( 12 , 41 , 42 ).…”