Sperduto Paul W, Jiang Wen, Brown Paul D, Braunstein Steve, Sneed Penny, Wattson Daniel A, Shih Helen A, Bangdiwala Ananta, Shanley Ryan, Lockney Natalie A, Beal Kathryn, Lou Emil, Amatruda Thomas, Sperduto William A, Kirkpatrick John P, Yeh Norman, Gaspar Laurie E, Molitoris Jason K, Masucci Laura, Roberge David, Yu James, Chiang Veronica, Mehta Minesh
Minneapolis Radiation Oncology, Minneapolis, Minnesota.
MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):812-816. doi: 10.1016/j.ijrobp.2017.06.2454.
To update the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for a markedly heterogeneous patient population, patients with melanoma and brain metastases, using a larger, more current cohort, including molecular markers.
The original Melanoma-GPA is based on data from 483 patients whose conditions were diagnosed between 1985 and 2005. This is a multi-institutional retrospective database analysis of 823 melanoma patients with newly diagnosed brain metastases from January 1, 2006, to December 31, 2015. Multivariable analyses identified significant prognostic factors, which were weighted and included in the updated index (Melanoma-molGPA). Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios to design the updated Melanoma-molGPA in which scores of 4.0 and 0.0 are associated with the best and worst prognoses, as with all of the diagnosis-specific GPA indices. Log-rank tests were used to compare adjacent classes.
There were 5 significant prognostic factors for survival (age, Karnofsky performance status [KPS], extracranial metastases [ECM], number of brain metastases, and BRAF status), whereas only KPS and the number of brain metastases were significant in the original Melanoma-GPA. Median survival improved from 6.7 to 9.8 months between the 2 treatment eras, and the median survival times for patients with Melanoma-molGPA of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 were 4.9, 8.3, 15.8, and 34.1 months (P<.0001 between each adjacent group).
Survival and our ability to estimate survival in melanoma patients with brain metastases has improved significantly. The updated Melanoma-molGPA, a user-friendly tool to estimate survival, will facilitate clinical decision making regarding whether and which treatment is appropriate and will also be useful for stratification of future clinical trials. To further simplify use, a free online/smart phone app is available at brainmetgpa.com.
使用一个更大、更新的队列（包括分子标志物），对显著异质性的患者群体——黑色素瘤脑转移患者，更新特定诊断分级预后评估（DS-GPA）。
最初的黑色素瘤-GPA基于1985年至2005年期间诊断的483例患者的数据。这是一项多机构回顾性数据库分析，纳入了2006年1月1日至2015年12月31日期间新诊断为脑转移的823例黑色素瘤患者。多变量分析确定了显著的预后因素，对这些因素进行加权并纳入更新后的指数（黑色素瘤-molGPA）。使用多重Cox回归按危险比比例选择和加权预后因素，以设计更新后的黑色素瘤-molGPA，其中4.0分和0.0分分别与最佳和最差预后相关，这与所有特定诊断的GPA指数相同。使用对数秩检验比较相邻类别。
有5个生存的显著预后因素（年龄、卡诺夫斯基体能状态[KPS]、颅外转移[ECM]、脑转移灶数量和BRAF状态），而在最初的黑色素瘤-GPA中只有KPS和脑转移灶数量是显著的。两个治疗时代之间的中位生存期从6.7个月提高到9.8个月，黑色素瘤-molGPA为0至1.0、1.5至2.0、2.5至3.0和3.5至·4.0的患者的中位生存时间分别为4.9、8.3、15.8和34.1个月（各相邻组之间P<0.0001）。
黑色素瘤脑转移患者的生存率及我们对生存率的估计能力有了显著提高。更新后的黑色素瘤-molGPA是一种便于用户使用的估计生存率的工具，将有助于临床决策，确定是否以及哪种治疗方法合适，也将有助于未来临床试验的分层。为进一步简化使用，可在brainmetgpa.com上获取免费的在线/智能手机应用程序。
