Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery
Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery
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DOI：
10.1016/j.radonc.2019.08.011
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发表时间：
2020-01-01
影响因子：
5.7
通讯作者：
Chan, Michael D.
中科院分区：
文献类型：
--
作者：
McTyre, Emory R.;Soike, Michael H.;Chan, Michael D.
简介：脑转移速度 (BMV) 是一种预后指标，描述放射外科 (SRS) 初始治疗后新脑转移的复发率。我们之前将患者分为高风险、中风险和低风险 BMV 组，这与总生存期 (OS) 相关。我们试图在多机构环境中对 BMV 进行外部验证。方法：来自 9 个学术中心的患者接受了前期 SRS 治疗；验证队列由来自八个机构的数据组成，这些数据以前未用于定义 BMV。根据 BMV 将患者分为低（13 BMV）。使用 Kaplan-Meier 方法估计事件发生时间结果。使用 Cox 比例风险方法来估计 BMV 和挽救方式对 OS 的影响。结果：在 2829 名患者中，2092 名患者包含在验证数据集中。其中，921 人（44.0%）经历了远端脑衰竭（DBF）。初始 SRS 的中位 OS 为 11.2 个月。 BMV < 4、BMV 4-13 和 BMV > 13 的中位 OS 分别为 12.5 个月、7.0 个月和 4.6 个月 (p < 0.0001)。经过多变量回归建模后，黑色素瘤组织学（β：10.10，SE：1.89，p < 0.0001）和初始脑转移数量（β：1.52，SE：0.34，p < 0.0001）仍然可以预测 BMV（调整后的 R-2 = 0.06）。结论：该多机构数据集验证了 BMV 作为 OS 的预测因子初始 SRS 之后。 BMV 正在即将进行的多机构随机对照试验中用作 DBF 后挽救性全脑辐射与挽救性 SRS 的分层变量。 (C) 2019 Elsevier B.V. 保留所有权利。
Introduction: Brain metastasis velocity (BMV) is a prognostic metric that describes the recurrence rate of new brain metastases after initial treatment with radiosurgery (SRS). We have previously risk stratified patients into high, intermediate, and low-risk BMV groups, which correlates with overall survival (OS). We sought to externally validate BMV in a multi-institutional setting.Methods: Patients from nine academic centers were treated with upfront SRS; the validation cohort consisted of data from eight institutions not previously used to define BMV. Patients were classified by BMV into low (13 BMV). Time-to-event outcomes were estimated using the Kaplan-Meier method. Cox proportional hazards methods were used to estimate the effect of BMV and salvage modality on OS.Results: Of 2829 patients, 2092 patients were included in the validation dataset. Of these, 921 (44.0%) experienced distant brain failure (DBF). Median OS from initial SRS was 11.2 mo. Median OS for BMV < 4, BMV 4-13, and BMV > 13 were 12.5 mo, 7.0 mo, and 4.6 mo (p < 0.0001). After multivariate regression modeling, melanoma histology (beta: 10.10, SE: 1.89, p < 0.0001) and number of initial brain metastases (beta: 1.52, SE: 0.34, p < 0.0001) remained predictive of BMV (adjusted R-2 = 0.06).Conclusions: This multi-institutional dataset validates BMV as a predictor of OS following initial SRS. BMV is being utilized in upcoming multi-institutional randomized controlled trials as a stratification variable for salvage whole brain radiation versus salvage SRS after DBF. (C) 2019 Elsevier B.V. All rights reserved.