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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

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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.