Prognostic factors derived from recursive partition analysis (RPA) of radiation therapy oncology group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases

Agboola, O.; Benoit, Brien G.; Cross, P.; Silva, Vasco Da; Esche, B.; Lesiuk, Howard; Gonsalves, Carol

doi:10.1016/s0360-3016(98)00198-9

Cited by 182 publications

(96 citation statements)

References 22 publications

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“…4 prognostic factors elicited from this study are classical survival determinants reported to be shared in common by all NSCLC whatever the metastatic site (Zimm et al, 1981;DienerWest et al, 1989;Komarnicky et al, 1991;Lonjon et al, 1994;Ryan et al, 1995;Ando et al, 1996;Auchter et al, 1996;Gaspar et al, 1997;Hsiung et al, 1998;Agboola et al, 1998;Lagerwaard et al, 1999), or by brain metastases whatever the primary tumour (Zimm et al, 1981;Diener-West et al, 1989;Komarnicky et al, 1991;Lonjon et al, 1994;Auchter et al, 1996;Gaspar et al, 1997;Agboola et al, 1998;Lagerwaard et al, 1999). These factors are gender, performance status, age and serum sodium level.…”

Section: Discussionmentioning

confidence: 70%

Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO* analysis of prognostic factors

et al. 2001

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Patients with lung cancer frequently suffer from brain metastases at the time of presentation. This condition affects approximately 10% of non-small cell lung cancer (NSCLC) patients (Newman and Hansen, 1974;Sorensen et al, 1988). Surgery is feasible only for a small proportion of these patients. Whole brain radiotherapy has been, hitherto, the generally recommended treatment in inoperable patients. The survival of NSCLC patients with brain metastases is poor, reported to be between 3 to 6 months in patients treated with medical therapies, either radiotherapy or chemotherapy (compared to 6-10 months in other advanced NSCLC (Paesmans et al, 1995;Shepherd, 1999)). Furthermore, brain metastases at the time of presentation of lung cancer seems to be a worse prognosis (Sorensen et al, 1988) than metachronous brain metastases.New therapeutic strategies are needed to improve the outcome of these patients. The knowledge of prognostic determinants might be important in both clinical trials and routine practice (Komaki et al, 1993;Charloux et al, 1997;Paesmans et al, 1997;Merrill et al, 1999). In the former setting, prognostic co-variables must be taken into account in survival analyses; by way of illustration, in a given randomized trial, the statement that a difference in survival is related to the effects of the treatment must be supported by a proportional hazards model demonstrating that this effect does not depend on well-known prognostic determinants (Depierre et al, 1999;Furuse et al, 1999). In the second setting, a therapeutic decision might be influenced by the state of prognostic variables (Komaki et al, 1993).Here we especially take a look at the prognostic significance of 2 specific serum markers, CYFRA 21-1 and neuron-specific enolase (NSE). The prognostic value of CYFRA 21-1 (a fragment of cytokeratin subunit 19) in this disease has been suggested (Pujol et al, 1993;Wieskopf et al, 1995;Brechot et al, 1997). NSE, the γ-subunit of enolase, has been widely investigated as a marker of small cell lung cancer (SCLC;Jorgensen et al, 1989). Although only a small proportion of NSCLC presented with a high NSE level, this marker might indirectly reflect; i) a neuroendocrine component of the disease in favour of tumour heterogeneity; ii) a Summary A multi-centre retrospective study involving 4 French university institutions has been conducted in order to identify routine pretherapeutic prognostic factors of survival in patients with previously untreated non-small cell lung cancer and brain metastases at the time of presentation. A total of 231 patients were recorded regarding their clinical, radiological and biological characteristics at presentation. The accrual period was January 1991 to December 1998. Prognosis was analysed using both univariate and multivariate (Cox model) statistics. The median survival of the whole population was 28 weeks. Univariate analysis (log-rank), showed that patients affected by one of the following characteristics proved to have a shorter survival in comparison with the opposite status...

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Section: Discussionmentioning

confidence: 70%

Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO* analysis of prognostic factors

et al. 2001

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“…This is unfortunate, as functional status is a strong predictor of survival in many neurological diseases, e.g., ischemic stroke, 27) aneurysmal subarachnoid hemorrhage, 23) malignant gliomas, 36,37) and brain metastases. 1,16) Since functional status is also an important outcome measure, despite the limited number of patients with analyzable data, we searched for predictors of postoperative functional status in the subset of patients with preand postoperative PS data. Cranial irradiation therapy dose AE40 Gy was the only factor that improved postoperative functional status as measured by the PS grade.…”

Section: Functional Statusmentioning

confidence: 99%

Management and Survival of Pineoblastoma: An Analysis of 34 Adults From the Brain Tumor Registry of Japan

Lee

Wakabayashi

Yoshida

2005

Neurol. Med. Chir.(Tokyo)

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Pineoblastoma is a rare tumor in adults, and factors influencing survival are poorly understood. Data from the Brain Tumor Registry of Japan (BTRJ) was analyzed to examine patient, tumor, and treatment characteristics associated with increased survival in adults with pineoblastomas. All pineoblastoma cases in adults aged 16 years or older were identified in the BTRJ. Data were extracted on demographics, presentation, tumor characteristics, treatments, and outcomes. Kaplan-Meier plots, the log rank method, and p value º0.15 was used to screen variables for inclusion in a multivariate Cox regression estimating survival. In the final Cox multivariate model, all variables with p values º0.05 were considered significant predictors of survival, and all variables with p values 0.05-0.099 were considered trends. The BTRJ contained 34 adults with pineoblastomas diagnosed from 1969-1998. The patients were predominantly male (22 patients), with a median age of 35 years (range 16-66 years). Median survival from diagnosis was 25.7 months, with a median follow up of 20.5 months. Median surgical resection was 75-94%, and five of the 34 patients had gross total resection. Twenty-nine of the 34 patients received cranial irradiation therapy with a median dose of 50 Gy (range 30-70 Gy). In the final multivariate model, cranial irradiation AE40 Gy (p ＝ 0.014) and gross total resection (p ＝ 0.034) were associated with improved survival. There was a trend towards improved survival for women (p ＝ 0.099). Adult pineoblastoma patients have poor survival prognosis. Cranial irradiation therapy using at least 40 Gy and complete surgical resection are associated with improved survival.

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“…9,29 These classification systems have been mainly validated in patient populations treated with radiotherapy. 1,6,10 A simple and reliable marker that reflects the systemic conditions of patients with brain metastases is needed in the decision-making process for resection. 21,23,26,31 Interest in the host inflammatory response to neoplasms is increasing.…”

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confidence: 99%

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Mitsuya¹,

Nakasu²,

Kurakane

et al. 2017

Journal of Neurosurgery

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B rain metastases occur in 10% to 40% of patients with cancer and are the most common central nervous system neoplasm in adults. 28,33 With increased surveillance, improved control of systemic cancer, and prolonged survival, the incidence of patients with brain metastases is increasing. 17 The management of brain metastases has been revolutionized in clinical oncology by 4 developments: improved brain imaging, improved management of systemic diseases, the distribution of stereotactic irradiation, and the extension of less invasive surgical techniques that enable brain metastases to be removed even from eloquent brain areas with minimal morbidity. 5Although stereotactic irradiation and pharmacotherapies contribute to the treatment outcome of patients with brain metastasis, resection is still a mainstay for large brain metastases.The indications for resection include a symptomatic mass, a mass with considerable edema requiring high-dose ABBREVIATIONS DS-GPA = diagnosis-specific graded prognostic assessment; KPS = Karnofsky Performance Status; NLR = neutrophil-to-lymphocyte ratio; OS = overall survival; RPA = recursive partitioning analysis. SUBMITTED OBJECTIVEThe median postoperative survival duration of patients with brain metastases who undergo tumor resection is 12 months. Most of these patients die of systemic metastases or the progression of primary cancer but not brain metastases. The criteria for indicating resection are still controversial. Systemic assessment is restricted, especially in patients who need emergent management for their large-size or life-threatening brain metastases. The neutrophil-tolymphocyte ratio (NLR) is reported to correlate with survival time or progression-free survival in patients with various cancers. However, NLR has not been assessed in patients with brain metastases. The impact of NLR on the survival data of patients who had undergone resection of brain metastases was retrospectively analyzed. METHODS The clinical records of patients who underwent resection of brain metastases at Shizuoka Cancer Center between May 2007 and January 2015 were retrospectively analyzed. NLR was calculated by using the data obtained from the latest examination before resection and before the administration of steroid therapy. Kaplan-Meier curves were used for the assessment of overall survival (OS). RESULTS Of the 105 patients included, 67 patients were male. The median age of the patients was 63 years (range 36-90 years). The primary cancers were lung, colon, breast, uterus, and other cancers in 48, 19, 10, 8, and 20 patients, respectively. The postresection median survival duration was 12 months (range 1-91 months) for the entire series. The optimum NLR threshold value was identified as 5. A significant difference in the median OS was found: 14 months for 82 patients with an NLR < 5 versus 5 months for 23 patients with an NLR ≥ 5 (p = 0.001). CONCLUSIONS In this study, an elevated preoperative NLR is a predictor of worse survival after resection for brain metastases. NLR is a simple, systemic m...

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Prognostic factors derived from recursive partition analysis (RPA) of radiation therapy oncology group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases

Cited by 182 publications

References 22 publications

Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO* analysis of prognostic factors

Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO* analysis of prognostic factors

Management and Survival of Pineoblastoma: An Analysis of 34 Adults From the Brain Tumor Registry of Japan

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

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