Survival time following resection of intracranial metastases from NSCLC-development and validation of a novel nomogram

Abstract

BackgroundBrain metastases (BM) from non-small cell lung cancer (NSCLC) are the most frequent intracranial tumors. To identify patients who might benefit from intracranial surgery, we compared the six existing prognostic indexes(PIs) and built a nomogram to predict the survival for NSCLC with BM before they intended to receive total intracranial resection in China.MethodsFirst, clinical data of NSCLC presenting with BM were retrospectively reviewed. All of the patients had received total intracranial resection and were randomly distributed to developing cohort and validation cohort by 2:1. Second, we stratified the cohort using a recursive partitioning analysis(RPA), a score index for radiosurgery (SIR), a basic score for BM (BS-BM), a Golden Grading System (GGS), a disease-specific graded prognostic assessment (DS-GPA) and by NSCLC-RADES. The predictive power of the six PIs was assessed using the Kaplan–Meier method and the log-rank test. Third, univariate and multivariate analysis were explored, and the nomogram predicting survival of BMs from NSCLC was constructed using R 3.2.3 software. The concordance index (C-index) was calculated to evaluate the discriminatory power of the nomogram in the developing cohort and validation cohort.ResultsBS-BM could better predict survival of patients before intracranial surgery compared with other PIs. In the final multivariate analysis, KPS at diagnosis of BM, metachronous or synchronous BM and the histology of lung cancer appeared to be the independent prognostic predictors for survival. The C-index in the developing cohort and validation cohort were 0.75 and 0.71 respectively, which was better than the C-index of the other six PIs.ConclusionsThe new nomogram is a promising tool in further choosing the candidates for intracranial surgery among NSCLC with BM and in helping physicians tailor suitable treatment options before operation in clinical practice.

Analysis of Survival of the Patients with Brain Metastases from Lung Cancer according to Treatment Modalities and Prognostic Indexes

“…[16] In our study, DS-GPA was not statistically significant for OS, while it was statistically significant in other studies. [15,43,38] Modified Lung-Specific GPA improved the OS of patients with brain metastasis from lung cancer, similar to our study. [17] Limitations of the Study Our study has several limitations.…”

“…[37,6] Ji et al showed that overall survival was increased in patients with favorable KPS on univariate analysis and multivariate analyses. [38] In our study, OS was increased in patients with favorable KPS, control of the extracranial disease, controlled primary tumor as reported by Gao. [39] Our series also matches with previous reports that have demonstrated improved median OS with better control of the extracranial disease.…”

“…[43] In other retrospective study of 335 patients by Ji et al, RPA and BS-BM were statistically significant for OS, similar to our study. [38] In the study of 1960 cases with BM by Sperduto, GPA was an appropriate prognostic index. [16] In our study, DS-GPA was not statistically significant for OS, while it was statistically significant in other studies.…”

Prognosis of lung cancer with simple brain metastasis patients and establishment of survival prediction models: a study based on real events

“…In our subject-related areas, current researches included prognostic analysis of tumor brain metastasis [ 34 ], survival analysis of non-small cell lung cancer (NSCLC) after surgical resection [ 33 ], and prognosis of NSCLC brain metastasis after surgery [ 35 , 36 ], but there had not been a LCSBM prognostic prediction model. Therefore, it was necessary to examine prognostic risk factors for such patients and establish a reliable prediction model.…”

The role of brain metastases in patients with pulmonary adenocarcinoma: a retrospective study

“…This study showed that KPS was related to OS in this patient population, and this is supported by other studies. A study that aimed to predict the survival of patients with NSCLC and brain metastasis showed that KPS at diagnosis of brain metastasis was an independent predictor of survival (32). Another study showed that a KPS of 90% vs. 70-80% was a significant prognostic factor after radical treatment for oligometastatic NSCLC (33).…”