Validation of the graded prognostic assessment for lung cancer with brain metastases using molecular markers (lung-molGPA)

Abstract

BackgroundMany patients with brain metastases from non-small cell lung cancer have limited survival, while others survive for several years, depending on patterns of spread, EGFR and ALK alterations, among others. The purpose of this study was to validate a new prognostic model (Lung-molGPA) originally derived from a North American database.Patients and methodsThis retrospective study included 269 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status, histology, EGFR and ALK alterations was collected. The Lung-molGPA score was calculated as described by Sperduto et al.ResultsMedian survival was 5.4 months. The score predicted survival in patients with adenocarcinoma histology and those with other types. For example, median survival was 3.0, 6.2, 14.7 and 25.0 months in the 4 different prognostic strata for adenocarcinoma. The corresponding figures were 2.4, 5.5 and 12.5 months in the 3 different prognostic strata for non-adenocarcinoma.ConclusionsThese results confirm the validity of the Lung-molGPA in an independent dataset from a different geographical region. However, median survival was shorter in 6 of 7 prognostic strata. Potential explanations include lead time bias and differences in treatment selection, both brain metastases-directed and systemically.

External validation of a prognostic score predicting overall survival for patients with brain metastases based on extracranial factors

“…Several methodologies on the way to prognostic tools for discrimination of patient populations benefiting from more aggressive treatment were developed [2], [16] and validated [17], [18], [19].…”

Non-small cell lung cancer brain metastases and the immune system: From brain metastases development to treatment

“…Moreover, it would be of value to evaluate whether advanced imaging techniques or radiomics analyses cannot only discriminate between real progression and pseudoprogression, but also can be predictive for response on ICI. Prognostic scores such as the Recursive Partitioning Analysis (RPA) score, disease specific -Graded Prognostic Assessment (ds-GPA) and the molecular-GPA are validated for NSCLC BM patients but these scores were established before the use of ICI [91][92][93][94]. It would be of interest to validate these scores also for BM patients treated with ICI.…”

Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

“…In contrast, development of distant brain failure often results in need for further SRS or WBRT (9,10). Besides local brain control, a variety of other factors that can be combined in prognostic scores are crucial determinants of long-term survival (5,6,8,16,17).…”