External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

Nieder, Carsten; Hess, Sebastian; Lewitzki, V.

doi:10.1159/000506954

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…In contrast to other prognostic models (20)(21)(22), the present one is not well suited to predict extremely short survival (even patients with 0-1 points sometimes survived for more than 3 months). This fact is not surprising, given that 3-year survival was the landmark chosen by the Japanese group.…”

Section: Discussioncontrasting

confidence: 58%

Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery

Nieder

Mannsåker

Yobuta

2021

In Vivo

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Background/Aim: The aim of this study was to analyze the survival predictions obtained from a recent graded prognostic model developed and validated in Japan. Patients and Methods: This was a retrospective singleinstitution analysis of 249 patients, managed with wholebrain radiotherapy for brain metastases. The sum of scores was calculated as in the Japanese study. The following parameters were included: number of brain metastases, volume of the largest lesion, sex, Karnofsky performance status, primary cancer type, control of primary cancer, and presence of extra-cerebral metastases. Results: Median overall survival was 3.0 months (95% CI= 2.6-3.4 months). The median sum of scores was 12, range=0-29. Statistically significant differences were observed between all prognostic strata. Conclusion: The graded prognostic model is also applicable to patients treated with whole-brain rather than stereotactic radiotherapy.Parallel to changes in the treatment of brain metastases from solid tumors, more advanced prognostic models have been developed (1-6). In recent years, different models for different types of primary tumors have been proposed, e.g., melanomaor renal cell carcinoma-specific prognostic scores (7-12). Nevertheless, a universally applicable score can still be considered advantageous due to its less complicated assignment in a busy working environment. Both three-and four-tiered scores have been validated and sometimes used for stratification in prospective clinical studies. Recently, Sato et al. have published a graded prognostic model for patients surviving 3 years or more after stereotactic radiosurgery (13). These authors assigned scores for seven statistically significant factors, i.e., number of brain metastases 1 vs. 2-4 vs. ≥5 (score; 6/1/0), volume of the largest lesion <10 ml vs. ≥10 ml (4/0), female/male sex (5/0), Karnofsky performance status (KPS) ≥80% vs. <80% (5/0), primary cancers of breast/lung/gastrointestinal tract/other (1/0/3/0), controlled primary cancer vs. uncontrolled primary cancer (8/0) and presence of extra-cerebral metastases vs. no extra-cerebral metastases (5/0). Patients were categorized into four strata according to the sum of scores, i.e., 0-9, 10-19, 20-29 and 30-36. The 3-year survival rates ranged between 0.7 and 45.1%. The median survival was 3.6, 6.8, 15.0 and 32.8 months, respectively. Relatively similar results were obtained in patients irradiated at a different institution in the same country (Japan), i.e. in a validation cohort (13). The aim of the present study was to provide additional data about the performance of this new prognostic model. In order to challenge its validity in several ways, patients managed in a different geographical region and with a different strategy (primary whole-brain radiotherapy, WBRT) were selected.

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Section: Discussioncontrasting

confidence: 58%

Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery

Nieder

Mannsåker

Yobuta

2021

In Vivo

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“…Besides established baseline parameters such as age, sex, number of brain metastases and Karnofsky PS, blood test results were included (hemoglobin, platelets, C-reactive protein, albumin, lactate dehydrogenase (LDH); the components of the LabBM score, which was assigned as originally recommended [ 16 ]). These were also employed to assign the LDH/albumin-based extracranial score (EC-S) [ 15 ]. The pattern and number of extracranial sites was registered (uncontrolled primary tumor, liver, lung, bone and other extracranial metastases; standard staging considered appropriate by the treating physicians at the time of treatment, thus subject to temporal and cancer-type-related variation [ 17 ]).…”

Section: Methodsmentioning

confidence: 99%

“…General survival prediction models such as TEACHH may also be utilized [ 11 , 12 ], but it is still unclear whether a brain metastases-specific 30-day mortality model should be preferred. Our group has previously studied different models that predict very short survival (not specifically focused on 30 days), but none of these was considered truly satisfactory [ 13 – 15 ]. The fact that many patients with poor prognosis were not identified by any model was considered a major challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Most patients with comparably short survival had a lower point sum. The LabPS score failed to outperform the previously proposed extracranial-graded prognostic assessment score (EC-GPA) [ 15 ]. Median survival was 0.7 months in the worst prognostic group of the latter score, with a hazard ratio for death of 44 (95% confidence interval (CI), 6–340) compared to the best group.…”

Section: Introductionmentioning

confidence: 99%

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30-day mortality in patients treated for brain metastases: extracranial causes dominate

et al. 2022

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Background Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. Methods Retrospective analysis (2011–2021) of patients treated for brain metastases with different approaches. Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. Results The cause of death was unrelated to brain metastases in 61%. Treatment-related death (grade 5 toxicity) did not occur. Completely unexpected death was not observed, e.g. accident, suicide or sudden cardiac death. Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 3–6 points) and a point sum was calculated for each patient. The point sum ranged from 0 (no risk factors for death within 30 days present) to 30. The results can be grouped into 3 or 4 risk categories. Eighty-three percent of patients in the highest risk group (> 16 points) died within 30 days, and none survived for more than 2 months. However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. Conclusion Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. We were able to develop a multifactorial prediction model. However, the model’s performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings.

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“…The latter assessment is often based on well-established prognostic models such as scores and nomograms [2,[24][25][26][27]. One of the aims of careful evaluation is to avoid unnecessarily complicated treatment in the final stage of disease [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

2021

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Purpose: The purpose of this study was to identify factors associated with the initiation or continuation of systemic treatment after brain irradiation. The outcome of interest was a utilization rate of at least 75%, given that active extracranial disease is common in patients with brain metastases. If left untreated, extracranial disease limits survival, regardless of successful local treatment of the brain metastases. In this context, systemic therapy has been shown to improve survival, e.g., after whole-brain radiotherapy. Patients and Methods: The study included 185 patients with active extracranial disease, 60% of whom received systemic therapy. Results: Survival from the start of brain irradiation was longest in patients who received additional immune checkpoint inhibitors, endocrine treatment, or anti-HER-2 drugs. After uni- and multivariate analyses, Eastern Cooperative Oncology Group performance status (PS) was selected as the first prediction criterion in the recursive partitioning analysis (RPA) decision tree analysis. RPA was successful for patients with PS 0–1, but patients with PS 2 had lower treatment utilization rates (maximum 60–70%, with a disease-dependent impact of age and LabBM score [blood test results]). The highest utilization rates were observed in (1) patients with PS 0 and (2) those with breast cancer, small-cell lung cancer, or lung adenocarcinoma with PS 1. Conclusions: These results inform the multidisciplinary discussion and treatment planning for the common scenario of simultaneous intra- and extracranial metastases.

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External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

Cited by 9 publications

References 26 publications

Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery

Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery

30-day mortality in patients treated for brain metastases: extracranial causes dominate

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

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