Email updates

Keep up to date with the latest news and content from Radiation Oncology and BioMed Central.

Open Access Highly Accessed Research

Validation of the new graded prognostic assessment scale for brain metastases: a multicenter prospective study

Salvador Villà1, Damien C Weber2*, Cristina Moretones1, Anabel Mañes1, Christophe Combescure2, Josep Jové1, Paloma Puyalto3, Patricia Cuadras3, Jordi Bruna4, Eugènia Verger5, Carme Balañà1 and Francesc Graus6

Author Affiliations

1 Department of Radiation Oncology, Catalan Institute of Oncology, HU Germans Trias, ICO, Badalona, Spain

2 Department of Radiation Oncology and Clinical Epidemiology, Geneva University Hospital, Geneva, Switzerland

3 Department of Radiology, HU Germans Trias, ICO, Badalona, Spain

4 Department of Neurology, HU Bellvitge. L'Hospitalet, Spain

5 Hospital Clinic, Barcelona, Spain

6 Department of Neurology, Hospital Clínic, Barcelona, Spain

For all author emails, please log on.

Radiation Oncology 2011, 6:23  doi:10.1186/1748-717X-6-23

Published: 2 March 2011

Abstract

Background

Prognostic indexes are useful to guide tailored treatment strategies for cancer patients with brain metastasis (BM). We evaluated the new Graded Prognostic Assessment (GPA) scale in a prospective validation study to compare it with two published prognostic indexes.

Methods

A total of 285 newly diagnosed BM (n = 85 with synchronous BM) patients, accrued prospectively between 2000 and 2009, were included in this analysis. Mean age was 62 ± 12.0 years. The median KPS and number of BM was 70 (range, 20-100) and 3 (range, 1-50), respectively. The majority of primary tumours were lung (53%), or breast (17%) cancers. Treatment was administered to 255 (89.5%) patients. Only a minority of patients could be classified prospectively in a favourable prognostic class: GPA 3.5-4: 3.9%; recursive partitioning analysis (RPA) 1, 8.4% and Basic Score for BM (BSBM) 3, 9.1%. Mean follow-up (FU) time was 5.2 ± 4.7 months.

Results

During the period of FU, 225 (78.9%) patients died. The 6 months- and 1 year-OS was 36.9% and 17.6%, respectively. On multivariate analysis, performance status (P < 0.001), BSBM (P < 0.001), Center (P = 0.007), RPA (P = 0.02) and GPA (P = 0.03) were statistically significant for OS. The survival prediction performances' of all indexes were identical. Noteworthy, the significant OS difference observed within 3 months of diagnosis between the BSBM, RPA and GPA classes/groups was not observed after this cut-off time point. Harrell's concordance indexes C were 0.58, 0.61 and 0.58 for the GPA, BSBM and RPA, respectively.

Conclusions

Our data suggest that the new GPA index is a valid prognostic index. In this prospective study, the prediction performance was as good as the BSBM or RPA systems. These published indexes may however have limited long term prognostication capability.