DIAGNOSIS-SPECIFIC PROGNOSTIC FACTORS, INDEXES, AND TREATMENT OUTCOMES FOR PATIENTS WITH NEWLY DIAGNOSED BRAIN METASTASES: A MULTI-INSTITUTIONAL ANALYSIS OF 4,259 PATIENTS
DIAGNOSIS-SPECIFIC PROGNOSTIC FACTORS, INDEXES, AND TREATMENT OUTCOMES FOR PATIENTS WITH NEWLY DIAGNOSED BRAIN METASTASES: A MULTI-INSTITUTIONAL ANALYSIS OF 4,259 PATIENTS
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DOI：
10.1016/j.ijrobp.2009.08.025
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发表时间：
2010-07-01
影响因子：
7
通讯作者：
Mehta, Minesh
中科院分区：
文献类型：
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作者：
Sperduto, Paul W.;Chao, Samuel T.;Mehta, Minesh
目的：关于脑转移瘤（BM）患者的最佳治疗存在争议。尽管有许多随机试验，但争论仍在继续，这可能是因为BM患者是一个异质性人群。本研究的目的是确定显着的诊断特异性预后因素和指标（诊断特异性分级预后评估[DS-GPA]）。方法和材料：1985年至2007年期间，从11个机构产生的5,067例BM治疗患者的回顾性数据库。在排除复发性BM或数据不完整的患者后，4，259例新诊断BM的患者仍有资格进行分析。根据原发部位和治疗方法对预后因素和结局进行单变量和多变量分析。确定有意义的预后因素，并用于定义DS-GPA预后指数。计算DS-GPA评分，并与预后相关，按诊断和治疗分层。对于非小细胞肺癌和小细胞肺癌，显著的预后因素是Karnofsky体力状态、年龄、颅外转移的存在和BM的数量，证实了这些诊断的原始GPA。对于黑色素瘤和肾细胞癌，显著的预后因素是Karnofsky体能状态和BM数量。对于乳腺癌和胃肠道癌，唯一显著的预后因素是Karnofsky体能状态。因此，设计了两个新的DS-GPA指数，用于乳腺癌/胃肠道癌和黑色素瘤/肾细胞癌。中位生存GPA评分，诊断和治疗determined.Conclusion：BM患者的预后因素因诊断而异。最初的GPA被证实为非小细胞肺癌和小细胞肺癌。新的DS-GPA指数被确定为其他组织学类型，并与结果相关，组间的统计学分离得到证实。这些数据应在未来随机试验的设计和临床决策中加以考虑。(C)2010年爱思唯尔公司
Purpose: Controversy endures regarding the optimal treatment of patients with brain metastases (BMs). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of the present study was to identify significant diagnosis-specific prognostic factors and indexes (Diagnosis-Specific Graded Prognostic Assessment [DS-GPA]).Methods and Materials: A retrospective database of 5,067 patients treated for BMs between 1985 and 2007 was generated from 11 institutions. After exclusion of the patients with recurrent BMs or incomplete data, 4,259 patients with newly diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of the prognostic factors and outcomes by primary site and treatment were performed. The significant prognostic factors were determined and used to define the DS-GPA prognostic indexes. The DS-GPA scores were calculated and correlated with the outcomes, stratified by diagnosis and treatment.Results: The significant prognostic factors varied by diagnosis. For non small-cell lung cancer and small-cell lung cancer, the significant prognostic factors were Karnofsky performance status, age, presence of extracranial metastases, and number of BMs, confirming the original GPA for these diagnoses. For melanoma and renal cell cancer, the significant prognostic factors were Karnofsky performance status and the number of BMs. For breast and gastrointestinal cancer, the only significant prognostic factor was the Karnofsky performance status. Two new DS-GPA indexes were thus designed for breast/gastrointestinal cancer and melanoma/renal cell carcinoma. The median survival by GPA score, diagnosis, and treatment were determined.Conclusion: The prognostic factors for BM patients varied by diagnosis. The original GPA was confirmed for non-small-cell lung cancer and small-cell lung cancer. New DS-GPA indexes were determined for other histologic types and correlated with the outcome, and statistical separation between the groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making. (C) 2010 Elsevier Inc.