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Zhang T, Zhang Y, Zhou L, Deng S, Huang M, Liu Y, Liu Y, Gong Y, Zhu J, Xue J, Bai Y, Ma H, Zhang Y, Yu M, Li Y, Wang Y, Zou B, Zhou X, Xiu W, Na F, Xu Y, Peng F, Wang J, Lu Y. Applicability of the adjusted graded prognostic assessment for lung cancer with brain metastases using molecular markers (Lung-molGPA) in a Chinese cohort: A retrospective study of multiple institutions. Cancer Med 2020; 9:8772-8781. [PMID: 33027555 PMCID: PMC7724493 DOI: 10.1002/cam4.3485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background In this era of precision medicine, prognostic heterogeneity is an important feature of patients with non‐small cell lung cancer (NSCLC) with brain metastases (BM). This multi‐institutional study is aimed to verify the applicability of the adjusted Lung‐molGPA model for NSCLC with BM in a Chinese cohort. Methods This retrospective study included 1903 patients at three hospitals in Southwest China. The performance of the Lung‐molGPA model was compared with that of the adjusted DS‐GPA model in terms of estimating the survival of NSCLC with BM. Results The median OS of this patient cohort was 27.0 months, and the adenocarcinoma survived longer than the non‐adenocarcinoma (28.0 months vs 18.7 months, p < 0.001). The adjusted Lung‐molGPA model was more accurate in predicting survival of adenocarcinoma patients than the adjusted DS‐GPA model (C‐index: 0.615 vs 0.571), and it was not suitable for predicting survival of non‐adenocarcinoma patients (p = 0.286, 1.5‐2.0 vs 2.5‐3.0; p = 0.410, 2.5‐3.0 vs 3.5‐4.0). Conclusions The adjusted Lung‐molGPA model is better than the DS‐GPA model in predicting the prognosis of adenocarcinoma patients. However, it failed to estimate the prognosis for non‐adenocarcinoma patients.
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Affiliation(s)
- Tingyou Zhang
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China.,Department of Thoracic Oncology, Zunyi Medical University NO.2 Affiliated Hospital, Zunyi, Guizhou, P.R. China
| | - Yu Zhang
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Lin Zhou
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Shanshan Deng
- Department of Thoracic Oncology, Zunyi Medical University NO.2 Affiliated Hospital, Zunyi, Guizhou, P.R. China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Yuncong Liu
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Yongmei Liu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Youlin Gong
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Jiang Zhu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Jianxin Xue
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Yuju Bai
- Department of Thoracic Oncology, Zunyi Medical University NO.2 Affiliated Hospital, Zunyi, Guizhou, P.R. China
| | - Hu Ma
- Department of Thoracic Oncology, Zunyi Medical University NO.2 Affiliated Hospital, Zunyi, Guizhou, P.R. China
| | - Yan Zhang
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Min Yu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Yanying Li
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Yongsheng Wang
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Bingwen Zou
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Weigang Xiu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Feifei Na
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Yong Xu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Feng Peng
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - Jin Wang
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
| | - You Lu
- Department of Thoracic Oncology, Cancer Centre, Sichuan University West China Hospital, Chengdu, Sichuan, P.R. China
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Rades D, Nguyen T, Janssen S, Schild SE. Development of a multivariable prediction model to estimate the remaining lifespan of elderly patients with cerebral metastases from small-cell lung cancer. Transl Lung Cancer Res 2020; 9:1433-1440. [PMID: 32953515 PMCID: PMC7481607 DOI: 10.21037/tlcr-20-327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prognostic tools estimating survival of elderly patients with cerebral metastases from small-cell lung cancer (SCLC) improve treatment personalization. A specific tool for these patients was developed and compared to existing instruments. Methods One-hundred-and-forty elderly patients (≥65 years) receiving whole-brain irradiation (WBI) for cerebral metastases from SCLC were retrospectively evaluated. WBI-program, age, gender, Karnofsky performance score, number of cerebral lesions, extracerebral metastases, and interval between SCLC-diagnosis and WBI were investigated. Characteristics significantly associated with survival in the multivariate analysis were used for the tool. Scoring points were calculated by dividing 6-month survival rates (%) by 10 and added for patient scores. The tool was compared to existing diagnosis-specific instruments including updated diagnosis-specific graded prognostic assessment (DS-GPA), Rades-SCLC and WBRT-30-SCLC. Results In the multivariate analysis, KPS (P<0.001), number of cerebral lesions (P=0.013) and extracerebral metastases (P=0.049) were significantly associated with survival. Patient scores of 2 (n=37), 5 (n=69), 8 (n=20) and 11 (n=14) points were obtained; 6-month survival rates were 0%, 9%, 50% and 79% (P<0.001). The positive predictive value (PPV) of the worst group (2 points) to identify patients dying ≤6 months was 100%; PPVs of updated DS-GPA, Rades-SCLC and WBRT-30-SCLC were 94%, 100% and 94%. PPV of the best group (11 points) to identify patients surviving ≥6 months was 79%; PPVs of updated DS-GPA, Rades-SCLC and WBRT-30-SCLC were 86%, 79% and 100%. Conclusions The most precise instruments were the new tool and Rades-SCLC for identification of patients dying ≤6 months, and the WBRT-30-SCLC to identify patients surviving ≥6 months.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Trang Nguyen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Rades D, Haus R, Janssen S, Schild SE. An easy-to-use scoring system to estimate the survival of patients irradiated for bone metastases from lung cancer. Transl Lung Cancer Res 2020; 9:1067-1073. [PMID: 32953485 PMCID: PMC7481577 DOI: 10.21037/tlcr-19-642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The remaining lifespan of patients with metastatic lung cancer should be considered when designing a personalized treatment program. To facilitate the estimation survival in lung cancer patients with bone metastases, a specific scoring system was created. Methods One-hundred-and-fifty-three patients receiving fractionated radiotherapy for bone metastases without spinal cord compression from lung cancer were included in this retrospective study. Age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, histology, interval from lung cancer diagnosis until irradiation of bone metastases, visceral metastases, additional bone metastases, type and number of irradiated sites, pathological fracture, upfront surgery and previous systemic treatment were evaluated for potential associations with survival. Those factors that were significant (P<0.05) or showed a trend (P≤0.10) on multivariate analysis were used to create the scoring system. Results On multivariate analysis, ECOG performance score was significant (risk ratio: 2.77, P<0.001), and age showed a trend (risk ratio: 1.34, P=0.10). The following scoring points were assigned: age ≤65 years =1 point, age ≥66 years =0 points, ECOG performance score of 0–1 =1 point, and ECOG performance score of ≥2 =0 points. Three prognostic groups were obtained: 0 points (n=38), 1 point (n=71) and 2 points (n=44). Six-month survival rates were 21%, 41% and 75%, 12-month survival rates 7%, 27% and 56% (P<0.001). Conclusions This scoring system can help estimate the remaining lifespan of lung cancer patients to be irradiated for bone metastases and will contribute to the personalization of their treatment.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Rapha Haus
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Gilbride L, Siker M, Bovi J, Gore E, Schultz C, Hall WA. Current Predictive Indices and Nomograms To Enable Personalization of Radiation Therapy for Patients With Secondary Malignant Neoplasms of the Central Nervous System: A Review. Neurosurgery 2019; 82:595-603. [PMID: 29669114 DOI: 10.1093/neuros/nyx631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/16/2018] [Indexed: 01/03/2023] Open
Abstract
The proper treatment of brain metastases continues to be a challenge for oncologists given the variability of individual patients' prognoses and the variety of treatment options available to address brain metasteses. There have been efforts since the 1990s to develop prognostic indices and nomograms to help clinicians determine the best approach for individuals with secondary malignant neoplasms of the central nervous system. A literature search was performed to identify the existing prognostic tools published between January 1995 and January 2017. While there have been several reported indices, many are limited by the number of patients analyzed or lack of generalizability. The most robust prognostic tools available are the Disease Specific Graded Prognostic Assessment and the Barnholtz-Sloan nomogram, both of which have online tools available to help clinicians. While these tools are helpful in stratifying different patients' outcomes, they are limited by their retrospective nature and likely underestimate survival in the modern era, where there is a rapidly growing arsenal of systemic agents available to patients with metastatic disease.
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Affiliation(s)
- Lucas Gilbride
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Malika Siker
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Joseph Bovi
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Elizabeth Gore
- Medical College of Wisconsin, Department of Radiation Oncology.,Clement J. Zablocki, VA Medical Center
| | | | - William A Hall
- Medical College of Wisconsin, Department of Radiation Oncology.,Clement J. Zablocki, VA Medical Center
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Rades D, Hansen HC, Schild SE, Janssen S. A New Diagnosis-Specific Survival Score for Patients to be Irradiated for Brain Metastases from Non-small Cell Lung Cancer. Lung 2019; 197:321-326. [PMID: 30927058 DOI: 10.1007/s00408-019-00223-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Personalized treatment helps one achieve optimal outcomes in patients with non-small cell lung cancer (NSCLC). Understanding patients' survival prognoses in a palliative situation like intracerebral metastases is critical. A new survival score, the WBRT-30-NSCLC, was developed for patients with intracerebral metastases from NSCLC. METHODS Eight factors were investigated in 157 patients receiving 10 × 3 Gy of whole-brain radiotherapy (WBRT) including age, gender, Karnofsky performance score (KPS), interval from diagnosis of NSCLC to WBRT, pre-WBRT systemic treatment, primary tumor control, number of intracerebral metastases, and metastasis outside the brain. Factors significant (p < 0.05) or showing a trend (p < 0.08) on multivariate analysis were used for the WBRT-30-NSCLC. Patient scores were derived by adding factor scores (6-month survival rates divided by 10). WBRT-30-NSCLC was compared to other scores for intracerebral metastases from NSCLC. RESULTS On multivariate analysis, age (p = 0.005), KPS (p < 0.001), systemic treatment (p = 0.018), and metastasis outside the brain (p < 0.001) were significant; number of intracerebral metastases (p = 0.075) showed a trend. Four groups were designed (912, 1317, 1820, and 22 points) with 6-month survival rates of 3, 26, 65, and 100%. Positive predictive value (PPV) to predict death ≤ 6 months after WBRT was 97% (updated DS-GPA classification 86%, Rades-NSCLC 88%), and PPV to predict survival ≥ 6 months was 100% (updated DS-GPA 78%, Rades-NSCLC 74%). CONCLUSIONS The WBRT-30-NSCLC appeared very precise in identifying patients with intracerebral metastases from NSCLC dying ≤ 6 months or surviving ≥ 6 months. It appeared more precise than previous scores and can support physicians developing personalized treatment regimens.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Heinke C Hansen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.,Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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Phuong PC, Nam LEV, Schild SE, Rades D, Khoa MT. A Survival Score Based on Symptoms and Performance Status for Patients with High-grade Gliomas Receiving Radiochemotherapy. In Vivo 2017; 31:689-693. [PMID: 28652440 DOI: 10.21873/invivo.11114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022]
Abstract
AIM To create a simple survival score for patients with high-grade gliomas based on clinical symptoms and performance status. PATIENTS AND METHODS Thirty-six patients received neurosurgical intervention followed by radiochemotherapy for high-grade gliomas. Six pre-treatment symptoms were included in the score depending on their impairment of quality of life, scoring each between 1 and 3. For each patient, the points from the symptoms were added and another 4 points were added for Karnofsky performance status (KPS) <80%. Based on the survival rates of these scores, two groups were formed: 1-4 (group A) and 5-12 points (group B). RESULTS The 1-, 2- and 3-year survival rates in group A were 100%, 33% and 24% in group A and 47%, 7% and 0% in group B (p<0.001). In addition, complete tumor resection (p<0.001) and tumor grade III (p<0.001) were associated with improved survival. CONCLUSION A simple survival score was developed helping physicians in decision-making for patients with high-grade gliomas.
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Affiliation(s)
- Pham Cam Phuong
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - LE Viet Nam
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.,Department of Nuclear Medicine, Ha Noi Medical University, Hanoi, Vietnam
| | - Mai Trong Khoa
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam.,Department of Nuclear Medicine, Ha Noi Medical University, Hanoi, Vietnam
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A New Score for Estimating Survival After Definitive Radiochemotherapy of Limited Disease Small Cell Lung Cancers. Lung 2016; 194:625-9. [PMID: 27140191 DOI: 10.1007/s00408-016-9886-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Most patients with limited disease small cell lung cancer (LD-SCLC) receive definitive radiochemotherapy. Some patients cannot withstand combined modality treatments. Patients with short life expectancies should receive less time-consuming programs. For patients with favorable prognoses, cure while avoiding late toxicity is important. Personalized treatment programs are required. An instrument to estimate the survival after radiochemotherapy of LD-SCLC was created. METHODS Seventy-one patients receiving definitive radiochemotherapy for LD-SCLC were retrospectively analyzed. Eight factors were evaluated for survival including gender, age, Karnofsky performance score, T-stage, N-stage, tumor substage, number of pack years, and pre-radiotherapy hemoglobin level. Factors that were significant (p < 0.05) or showed a trend (p ≤ 0.08) on multivariate analyses were incorporated in the score. Scoring points were derived from 2-year survival rates divided by 10 and added to scores for individual patients. RESULTS On multivariate analysis, gender (p = 0.03), performance score (p < 0.001), and pre-radiotherapy hemoglobin level (p = 0.04) were significant, and tumor substage showed a trend (p = 0.08). Taking into account the 2-year survival rates of these factors, scores for single patients ranged from 9 to 26 points. Three groups were identified: 9-13, 14-18, and 19-26 points. One-year survival rates were 8, 73, and 100 %, respectively (p < 0.001). Two-year survival rates were 0, 35, and 87 %, respectively (p < 0.001). The 3-year survival rates were 0, 19, and 75 %, respectively (p < 0.001). CONCLUSION This score including three groups with significantly different survival rates is a helpful instrument for personalization of therapy for patients with LD-SCLC. When using this instrument, the limitations if this study must be taken into account.
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