Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors.
Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors.
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DOI：
10.1016/j.ijrobp.2022.03.020
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发表时间：
2022-09-01
影响因子：
7
通讯作者：
Mehta, Minesh P.
中科院分区：
文献类型：
--
作者：
Sperduto, Paul W.;De, Brian;Li, Jing;Carpenter, David;Kirkpatrick, John;Milligan, Michael;Shih, Helen A.;Kutuk, Tugce;Kotecha, Rupesh;Higaki, Hajime;Otsuka, Manami;Aoyama, Hidefumi;Bourgoin, Malie;Roberge, David;Dajani, Salah;Sachdev, Sean;Gainey, Jordan;Buatti, John M.;Breen, William;Brown, Paul D.;Ni, Lisa;Braunstein, Steve;Gallitto, Matthew;Wang, Tony J. C.;Shanley, Ryan;Lou, Emil;Shiao, Jay;Gaspar, Laurie E.;Tanabe, Satoshi;Nakano, Toshimichi;An, Yi;Chiang, Veronica;Zeng, Liang;Soliman, Hany;Elhalawani, Hesham;Cagney, Daniel;Thomas, Evan;Boggs, Drexell H.;Ahluwalia, Manmeet S.;Mehta, Minesh P.
患有肺癌和脑转移的患者代表了显著异质性的人群。准确的预后是最佳个性化护理的关键。在之前的出版物中，我们描述了分级预后评估（GPA），但从未报道过小细胞肺癌（SCLC）患者的GPA，并且在非小细胞肺癌（NSCLC）中，程序性死亡配体1（PD-L1）的影响未知。这项工作的三重目的是提供SCLC GPA的初始报告，评价PD-L1对NSCLC患者生存期的影响，并相应更新肺部GPA。使用多机构回顾性数据库，对2015年1月1日至2020年12月31日期间新诊断脑转移的4183例肺癌患者（3002例腺癌，611例非腺癌，570例SCLC）进行了预后因素和与生存相关的治疗的多变量分析。使用重要变量更新肺部GPA。肺腺癌、小细胞肺癌和非腺癌的总体中位生存期分别为17、10和8个月，但GPA差异很大，从2个月到52个月不等。在小细胞肺癌中，重要的预后因素是年龄、体力状态、颅外转移和脑转移的数量。在NSCLC中，已知原发性肿瘤分子状态的肺腺癌患者的分子标志物分布显示，PD-L1 50%-100%、PD-L1 1%-49%、表皮生长因子受体和间变性淋巴瘤激酶的改变/表达分别为32%、31%、30%和7%。PD-L1表达为0、1%-49%和≥50%的肺腺癌和脑转移患者的中位生存期分别为17、19和24个月（P <0.01），证实PD-L1是一个预后因素。重申了先前确定的NSCLC预后因素（表皮生长因子受体和间变性淋巴瘤激酶状态、体能状态、年龄、脑转移灶数量和颅外转移灶）。将这些因素纳入更新的肺部GPA中，并在所有组织学亚组之间进行稳健分离。肺癌和脑转移患者的生存率有所改善，但差异很大。介绍了小细胞肺癌GPA的初步报告。对于NSCLC腺癌和脑转移患者，PD-L1是一个新发现的重要预后因素，并重申了先前确定的因素。更新后的指数为SCLC、NSCLC-非腺癌和NSCLC-腺癌（包含PD-L1）建立了独特的标准。更新的肺部GPA可在brainmetgpa.com免费获得，提供了一个准确的工具来估计生存率，个性化治疗和分层临床试验。
Patients with lung cancer and brain metastases represent a markedly heterogeneous population. Accurate prognosis is essential to optimally individualize care. In prior publications, we described the graded prognostic assessment (GPA), but a GPA for patients with small cell lung cancer (SCLC) has never been reported, and in non-small cell lung cancer (NSCLC), the effect of programmed death ligand 1 (PD-L1) was unknown. The 3-fold purpose of this work is to provide the initial report of an SCLC GPA, to evaluate the effect of PD-L1 on survival in patients with NSCLC, and to update the Lung GPA accordingly. A multivariable analysis of prognostic factors and treatments associated with survival was performed on 4183 patients with lung cancer (3002 adenocarcinoma, 611 nonadenocarcinoma, 570 SCLC) with newly diagnosed brain metastases between January 1, 2015, and December 31, 2020, using a multi-institutional retrospective database. Significant variables were used to update the Lung GPA. Overall median survival for lung adenocarcinoma, SCLC, and nonadenocarcinoma was 17, 10, and 8 months, respectively, but varied widely by GPA from 2 to 52 months. In SCLC, the significant prognostic factors were age, performance status, extracranial metastases, and number of brain metastases. In NSCLC, the distribution of molecular markers among patients with lung adenocarcinoma and known primary tumor molecular status revealed alterations/expression in PD-L1 50% to 100%, PD-L1 1% to 49%, epidermal growth factor receptor, and anaplastic lymphoma kinase in 32%, 31%, 30%, and 7%, respectively. Median survival of patients with lung adenocarcinoma and brain metastases with 0, 1% to 49%, and ≥50% PD-L1 expression was 17, 19, and 24 months, respectively (P < .01), confirming PD-L1 is a prognostic factor. Previously identified prognostic factors for NSCLC (epidermal growth factor receptor and anaplastic lymphoma kinase status, performance status, age, number of brain metastases, and extracranial metastases) were reaffirmed. These factors were incorporated into the updated Lung GPA with robust separation between subgroups for all histologies. Survival for patients with lung cancer and brain metastases has improved but varies widely. The initial report of a GPA for SCLC is presented. For patients with NSCLC-adenocarcinoma and brain metastases, PD-L1 is a newly identified significant prognostic factor, and the previously identified factors were reaffirmed. The updated indices establish unique criteria for SCLC, NSCLC-nonadenocarcinoma, and NSCLC-adenocarcinoma (incorporating PD-L1). The updated Lung GPA, available for free at brainmetgpa.com, provides an accurate tool to estimate survival, individualize treatment, and stratify clinical trials.
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影响因子：
168.9
作者：
Mulvenna, Paula;Nankivell, Matthew;Barton, Rachael;Faivre-Finn, Corinne;Wilson, Paula;McColl, Elaine;Moore, Barbara;Brisbane, Iona;Ardron, David;Holt, Tanya;Morgan, Sally;Lee, Caroline;Waite, Kathryn;Bayman, Neil;Pugh, Cheryl;Sydes, Benjamin;Stephens, Richard;Parmar, Mahesh K.;Langley, Ruth E.
通讯作者：
Langley, Ruth E.
影响因子：
51.1
作者：
Goldberg, Sarah B.;Schalper, Kurt A.;Kluger, Harriet M.
通讯作者：
Kluger, Harriet M.
影响因子：
120.7
作者：
Aoyama, Hidefumi;Shirato, Hiroki;Kobashi, Gen
通讯作者：
Kobashi, Gen
影响因子：
45.3
作者：
Gadgeel, Shirish;Rodriguez-Abreu, Delvys;Garassino, Marina C.
通讯作者：
Garassino, Marina C.
影响因子：
158.5
作者：
Aupérin, A;Arriagada, R;Aisner, J
通讯作者：
Aisner, J