Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases
Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases
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DOI：
10.1200/jco.2011.38.0527
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发表时间：
2012-02-01
影响因子：
45.3
通讯作者：
Mehta, Minesh
中科院分区：
文献类型：
--
作者：
Sperduto, Paul W.;Kased, Norbert;Mehta, Minesh
目的我们的研究小组此前发表了分级预后评估(GPA)，这是脑转移患者的预后指标。已经发布了更新，并进行了改进，以创建特定于诊断的分级预后评估指数。这份报告的目的是在一个单一的、统一的、用户友好的报告中呈现更新的诊断特异性GPA指数，以便于治疗医生访问和使用。方法一个多机构回顾数据库(1985-2007)对3940例新诊断的脑转移瘤患者进行了单因素和多因素分析，根据原发部位和治疗情况与预后相关。显著的预后因素被用来定义诊断特异性GPA预后指数。GPA为4.0的患者预后最好，而GPA为0.0的患者预后最差。对于肺癌，预后因素是Karnofsky功能评分、年龄、颅外转移的存在和脑转移的数量，证实了最初的肺GPA。对于黑色素瘤和肾细胞癌，预后因素是Karnofsky功能评分和脑转移数目。对于乳腺癌，预后因素是肿瘤亚型、卡诺夫斯基功能评分和年龄。对于胃肠道癌症，唯一的预后因素是卡诺夫斯基表现评分。结论脑转移瘤患者的预后因素因诊断的不同而不同，对于每个诊断，不同的GPA评分具有很强的区分能力，这意味着即使在同一种肿瘤类型内，预后也存在相当大的异质性。总而言之，这些指标和相关的工作表为脑转移患者提供了一种准确和简便的诊断特异性工具，用于估计生存时间、潜在地选择适当的治疗方法以及对临床试验进行分层。J Clin Oncol30：419-425。(C)2011年美国临床肿瘤学会
PurposeOur group has previously published the Graded Prognostic Assessment (GPA), a prognostic index for patients with brain metastases. Updates have been published with refinements to create diagnosis-specific Graded Prognostic Assessment indices. The purpose of this report is to present the updated diagnosis-specific GPA indices in a single, unified, user-friendly report to allow ease of access and use by treating physicians.MethodsA multi-institutional retrospective (1985 to 2007) database of 3,940 patients with newly diagnosed brain metastases underwent univariate and multivariate analyses of prognostic factors associated with outcomes by primary site and treatment. Significant prognostic factors were used to define the diagnosis-specific GPA prognostic indices. A GPA of 4.0 correlates with the best prognosis, whereas a GPA of 0.0 corresponds with the worst prognosis.ResultsSignificant prognostic factors varied by diagnosis. For lung cancer, prognostic factors were Karnofsky performance score, age, presence of extracranial metastases, and number of brain metastases, confirming the original Lung-GPA. For melanoma and renal cell cancer, prognostic factors were Karnofsky performance score and the number of brain metastases. For breast cancer, prognostic factors were tumor subtype, Karnofsky performance score, and age. For GI cancer, the only prognostic factor was the Karnofsky performance score. The median survival times by GPA score and diagnosis were determined.ConclusionPrognostic factors for patients with brain metastases vary by diagnosis, and for each diagnosis, a robust separation into different GPA scores was discerned, implying considerable heterogeneity in outcome, even within a single tumor type. In summary, these indices and related worksheet provide an accurate and facile diagnosis-specific tool to estimate survival, potentially select appropriate treatment, and stratify clinical trials for patients with brain metastases. J Clin Oncol 30: 419-425. (C) 2011 by American Society of Clinical Oncology