Retrospective study of 229 surgically treated patients with brain metastases: Prognostic factors, outcome and comparison of recursive partitioning analysis and diagnosis-specific graded prognostic assessment

Abstract

Background:Metastases are the most frequent tumors in the brain. Most often used scoring systems to predict the outcome are the RPA (Recursive Partitioning Analysis) classification and the DS-GPA (Diagnosis-Specific Graded Prognostic Assessment) score. The goal of our study was to determine prognostic factors which influence outcome in patients who undergo surgery for brain metastases and to compare different outcome scores.Methods:Two hundred and twenty-nine patients who underwent surgery for brain metastases in our institution between January 2005 and December 2014 were included in the study. Patient data were evaluated retrospectively.Results:The mean survival time was 19.2 months (median survival time, MST: 8 months), for patients with a single metastasis (n = 149) 17.6 months (MST: 8 months), and for patients with multiple metastases (n = 80) 17.9 months (MST: 6 months). Significant influence on MST had age <65 years (9 vs. 5 months, P = 0.002), female sex (10 vs. 6 months, P < 0.001), RPA Class I and II (11 vs. 4 months, P < 0.001), Karnofsky score >70% (11 vs. 4 months, P < 0.001), and postoperative radiotherapy (8 vs. 5 months, P < 0.002). To evaluate the diagnostic power of DS-GPA and RPA score in respect of survival, two Cox regressions were modeled, where the RPA classification showed a better predictive power.Conclusion:Favorable factors for prolonged survival were KPS >70%, RPA Class I and II, age <65 years, female sex, a DS-GPA Score of 2.5–3 and 3.5–4, and adjuvant radiotherapy. The RPA Classification was more accurate in predicting the outcome than the DS-GPA score.

Prognostic factors and outcome of surgically treated patients with brain metastases of non‐small cell lung cancer

“…The Radiation Therapy Oncology Group (RTOG) developed an RPA classification system in which patients are statistically classified by KPS score, age, and status of extracranial disease . In this study, patients were also classified into three classes according to the RPA classification: the median survival rates were 13.4 (class I), 9.1 (class II), and 2.4 (class III) months ( P < 0.001), similar to the results of previous reports . BM patients could also benefit from better KPS scores.…”

“…However, Pojskic et al . concluded that the mean survival of patients with multiple BM was not statistically different from that of patients with a single metastasis . Similarly, Hong et al .…”

“…17 In this study, patients were also classified into three classes according to the RPA classification: the median survival rates were 13.4 (class I), 9.1 (class II), and 2.4 (class III) months (P < 0.001), similar to the results of previous reports. 18,19 BM patients could also benefit from better KPS scores. The Cox hazard model suggested that RPA classification and KPS score were both independent factors that reduced the risk of death.…”

“…However, Pojskic et al concluded that the mean survival of patients with multiple BM was not statistically different from that of patients with a single metastasis. 18 Similarly, Hong et al showed that outcomes in patients with multiple symptomatic BM who underwent metastasectomy leaving asymptomatic lesions unresected were equivalent to outcomes in patients who underwent complete cerebral metastasectomy. 23 It is possible that postoperative patients received different drugs, the metastases had different molecular characteristics, or the patients had other diseases, which led to a faster death.…”

Research Progress and Challenges in the Treatment of Central Nervous System Metastasis of Non-Small Cell Lung Cancer

“…However, recent studies have shown that the average survival of patients with multiple BMs is not statistically different from that of patients with single metastasis [164].…”