Department of Medical Oncology, Erasmus MC Cancer Centre, Rotterdam, The Netherlands.
Gamma Knife Center Tilburg, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
J Neurooncol. 2018 Jun;138(2):391-399. doi: 10.1007/s11060-018-2808-6. Epub 2018 Feb 22.
Melanoma brain metastases (MBM) are common in patients with stage IV disease. For Gamma Knife radiosurgery (GKRS) on MBM, risk scores such as RPA and melanoma-GPA aid to identify prognostic subgroups. This study aimed to validate the overall survival (OS) risk score developed by Chowdhury et al. in our center's patient cohort. A total of 104 MBM patients were treated with GKRS between 1/1/2002 and 31/12/2014 in our institution. Patients were categorized according to RPA, melanoma-GPA and Chowdhury OS score. The Kaplan-Meier method was used to estimate overall survival, and predicted survival probabilities were calculated for calibration. Cox proportional hazards regressions were performed to identify additional risk factors. Overall, median follow-up time was 80 months, while median OS (mOS) after GKRS was 6 months. Stratified according to the Chowdhury OS score, mOS in the high, medium and low risk group was 3.4, 7.1, and 10.0 months, respectively. The addition of other patient or disease characteristics to the Chowdhury OS model did not improve its performance. The C-index of the melanoma-GPA was 0.46 while the Chowdhury OS had an index of 0.67. In comparison with the RPA and melanoma-GPA, the Chowdhury OS score more accurately distinguished between separate risk groups among patients with MBM treated with GKRS. Contrary to the original study by Chowdhury, follow-up time was sufficient here for the low-risk group to reach the mOS time of 10 months.
黑色素瘤脑转移（MBM）在 IV 期疾病患者中很常见。对于 MBM 的伽玛刀放射外科手术（GKRS），风险评分如 RPA 和黑色素瘤-GPA 有助于确定预后亚组。本研究旨在验证 Chowdhury 等人在我们中心患者队列中开发的总生存（OS）风险评分。在我们机构，2002 年 1 月 1 日至 2014 年 12 月 31 日期间，共有 104 例 MBM 患者接受 GKRS 治疗。患者根据 RPA、黑色素瘤-GPA 和 Chowdhury OS 评分进行分类。Kaplan-Meier 法用于估计总生存，计算校准的预测生存概率。进行 Cox 比例风险回归以确定其他风险因素。总体而言，中位随访时间为 80 个月，GKRS 后中位 OS（mOS）为 6 个月。根据 Chowdhury OS 评分分层，高危、中危和低危组的 mOS 分别为 3.4、7.1 和 10.0 个月。将其他患者或疾病特征添加到 Chowdhury OS 模型中并没有改善其性能。黑色素瘤-GPA 的 C 指数为 0.46，而 Chowdhury OS 的指数为 0.67。与 RPA 和黑色素瘤-GPA 相比，Chowdhury OS 评分更能准确区分接受 GKRS 治疗的 MBM 患者的不同风险组。与 Chowdhury 的原始研究相反，这里的随访时间足以使低危组达到 10 个月的 mOS 时间。
