Katsuta Hospital Mito GammaHouse, 5125-2 Nakane, Hitachi-naka, Ibaraki 312-0011, Japan.
J Neurooncol. 2013 Feb;111(3):327-35. doi: 10.1007/s11060-012-1019-9. Epub 2012 Dec 9.
We tested the validity of two prognostic indices for stereotactic radiosurgically (SRS)-treated patients with brain metastases (BMs) from five major original cancer categories. The two indices are Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) and our Modified Recursive Partitioning Analysis (RPA). Forty-six hundred and eight BM patients underwent gamma knife SRS during the 1998-2011 period. Primary cancer categories were non-small cell lung cancer (NSCLC, 2827 patients), small cell lung cancer (SCLC, 460), gastro-intestinal cancer (GIC, 582), breast cancer (BC, 547) and renal cell cancer (RCC, 192). There were statistically significant survival differences among patients stratified into four groups based on the DS-GPA systems (p < 0.001) in all five original cancer categories. In the NSCLC category, there were statistically significant mean survival time (MST) differences (p < 0.001) among the four groups without overlapping of 95 % confidence intervals (CIs) between any two pairs of groups with the DS-GPA system. However, among the SCLC, GIC, BC and RCC categories, MST differences between some pairs of groups failed to reach statistical significance with this system. There were, however, statistically significant MST differences (p < 0.001) among the three groups without overlapping of 95 % CIs between any two pairs of groups with the Modified RPA system in all five categories. The DS-GPA system is applicable to our set of patients with NSCLC only. However, the Modified RPA system was shown to be applicable to patients with five primary cancer categories. This index should be considered when designing future clinical trials involving BM patients.
我们测试了两种用于治疗脑转移瘤（BM）的立体定向放射外科（SRS）患者预后指数的有效性，这些患者来自五个主要的原发癌类别。这两个指数是诊断特异性分级预后评估（DS-GPA）和我们的改良递归分区分析（RPA）。1998 年至 2011 年间，有 4608 例 BM 患者接受了伽玛刀 SRS 治疗。原发癌类别为非小细胞肺癌（NSCLC，2827 例）、小细胞肺癌（SCLC，460 例）、胃肠道癌（GIC，582 例）、乳腺癌（BC，547 例）和肾细胞癌（RCC，192 例）。在基于 DS-GPA 系统将患者分为四组的情况下，所有五个原发癌类别之间的生存差异具有统计学意义（p < 0.001）。在 NSCLC 类别中，DS-GPA 系统中四组之间的平均生存时间（MST）差异具有统计学意义（p < 0.001），任何两组之间的 95%置信区间（CI）没有重叠。然而，在 SCLC、GIC、BC 和 RCC 类别中，DS-GPA 系统中某些组之间的 MST 差异没有达到统计学意义。然而，在所有五个类别中，改良 RPA 系统中三组之间的 MST 差异具有统计学意义（p < 0.001），任何两组之间的 95%CI 没有重叠。DS-GPA 系统仅适用于我们的 NSCLC 患者。然而，改良 RPA 系统适用于五种原发癌类别的患者。在设计涉及 BM 患者的未来临床试验时，应考虑该指数。
