Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota.
MD Anderson Cancer Center, Department of Radiation Oncology, Houston, Texas.
Neuro Oncol. 2018 Nov 12;20(12):1652-1660. doi: 10.1093/neuonc/noy099.
Brain metastases are a common complication of renal cell carcinoma (RCC). Our group previously published the Renal Graded Prognostic Assessment (GPA) tool. In our prior RCC study (n = 286, 1985-2005), we found marked heterogeneity and variation in outcomes. In our recent update in a larger, more contemporary cohort, we identified additional significant prognostic factors. The purpose of this study is to update the original Renal-GPA based on the newly identified prognostic factors.
A multi-institutional retrospective institutional review board-approved database of 711 RCC patients with new brain metastases diagnosed from January 1, 2006 to December 31, 2015 was created. Clinical parameters and treatment were correlated with survival. A revised Renal GPA index was designed by weighting the most significant factors in proportion to their hazard ratios and assigning scores such that the patients with the best and worst prognoses would have a GPA of 4.0 and 0.0, respectively.
The 4 most significant factors were Karnofsky performance status, number of brain metastases, extracranial metastases, and hemoglobin. The overall median survival was 12 months. Median survival for GPA groups 0-1.0, 1.5-2.0, 2.5-3, and 3.5-4.0 (% n = 25, 27, 30 and 17) was 4, 12, 17, and 35 months, respectively.
The updated Renal GPA is a user-friendly tool that will help clinicians and patients better understand prognosis, individualize clinical decision making and treatment selection, provide a means to compare retrospective literature, and provide more robust stratification of future clinical trials in this heterogeneous population. To simplify use of this tool in daily practice, a free online application is available at brainmetgpa.com.
脑转移是肾细胞癌（RCC）的常见并发症。我们的团队之前发表了肾脏分级预后评估（GPA）工具。在我们之前的 RCC 研究（n=286，1985-2005 年）中，我们发现结果存在明显的异质性和变化。在我们最近对更大、更现代队列的更新中，我们确定了其他重要的预后因素。本研究的目的是根据新发现的预后因素更新原始的肾脏-GPA。
创建了一个多机构回顾性机构审查委员会批准的数据库，其中包括 711 例 2006 年 1 月 1 日至 2015 年 12 月 31 日新诊断为脑转移的 RCC 患者。对临床参数和治疗与生存进行了相关性分析。根据危险比按比例加权最显著的因素，并分配分数，设计了一个新的肾脏 GPA 指数，使预后最好和最差的患者的 GPA 分别为 4.0 和 0.0。
最显著的 4 个因素是 Karnofsky 表现状态、脑转移数量、颅外转移和血红蛋白。总体中位生存期为 12 个月。GPA 组 0-1.0、1.5-2.0、2.5-3 和 3.5-4.0（%n=25、27、30 和 17）的中位生存时间分别为 4、12、17 和 35 个月。
更新后的肾脏 GPA 是一个用户友好的工具，将帮助临床医生和患者更好地理解预后，个体化临床决策和治疗选择，提供比较回顾性文献的方法，并为该异质人群的未来临床试验提供更强大的分层。为了在日常实践中简化使用该工具，我们提供了一个免费的在线应用程序，网址为 brainmetgpa.com。
