論文

査読有り
2020年9月15日

Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient

Journal of Clinical Oncology
  • Paul W. Sperduto
  • ,
  • Shane Mesko
  • ,
  • Jing Li
  • ,
  • Daniel Cagney
  • ,
  • Ayal Aizer
  • ,
  • Nancy U. Lin
  • ,
  • Eric Nesbit
  • ,
  • Tim J. Kruser
  • ,
  • Jason Chan
  • ,
  • Steve Braunstein
  • ,
  • Jessica Lee
  • ,
  • John P. Kirkpatrick
  • ,
  • Will Breen
  • ,
  • Paul D. Brown
  • ,
  • Diana Shi
  • ,
  • Helen A. Shih
  • ,
  • Hany Soliman
  • ,
  • Arjun Sahgal
  • ,
  • Ryan Shanley
  • ,
  • William A. Sperduto
  • ,
  • Emil Lou
  • ,
  • Ashlyn Everett
  • ,
  • Drexell H. Boggs
  • ,
  • Laura Masucci
  • ,
  • David Roberge
  • ,
  • Jill Remick
  • ,
  • Kristin Plichta
  • ,
  • John M. Buatti
  • ,
  • Supriya Jain
  • ,
  • Laurie E. Gaspar
  • ,
  • Cheng-Chia Wu
  • ,
  • Tony J.C. Wang
  • ,
  • John Bryant
  • ,
  • Michael Chuong
  • ,
  • Yi An
  • ,
  • Veronica Chiang
  • ,
  • Toshimichi Nakano
  • ,
  • Hidefumi Aoyama
  • ,
  • Minesh P. Mehta

開始ページ
JCO.20.01255
終了ページ
JCO.20.01255
記述言語
掲載種別
研究論文(学術雑誌)
DOI
10.1200/jco.20.01255
出版者・発行元
American Society of Clinical Oncology (ASCO)

<sec><title>PURPOSE</title> Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility.

</sec><sec><title>METHODS</title> A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively.

</sec><sec><title>RESULTS</title> Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation ( P &lt; .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non–small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively.

</sec><sec><title>CONCLUSION</title> Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient &gt; 0.50).

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リンク情報
DOI
https://doi.org/10.1200/jco.20.01255
URL
https://ascopubs.org/doi/pdfdirect/10.1200/JCO.20.01255

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