Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, 310022, China; Department of Oncology, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.
Lung Cancer. 2018 Nov;125:8-13. doi: 10.1016/j.lungcan.2018.08.023. Epub 2018 Aug 30.
The Lung-molGPA index is based on the original diagnosis-specific graded prognostic assessment (DS-GPA) and incorporates recently reported gene alteration data, predicting the outcomes of non-small cell lung cancer (NSCLC) patients with brain metastases (BM). However, the prognostic values of both DS-GPA and Lung-molGPA remain undetermined, especially for patients with different molecular types.
A total of 1184 NSCLC patients with BM were analyzed for clinical factors and outcomes at Zhejiang Cancer Hospital, China. All prognostic factors were weighted for significance by hazard ratios. The applicability of DS-GPA and Lung-molGPA were reappraised in NSCLC patients with BM and various genetic profiles. Additionally, a modified Lung-molGPA was newly developed for NSCLC patients with gene variations.
NSCLC patients in the present study had a median survival time of 14.0 months from BM diagnosis. Both the DS-GPA and Lung-molGPA models could effectively predict the outcomes of NSCLC patients with BM (P < 0.001), and the Lung-molGPA model appeared to deliver more accurate predictions. Furthermore, Lung-molGPA scores demonstrated discriminatory capability in patients with gene variations (P < 0.001), and no significant difference was reached in wild-type patients (P = 0.133). Regarding oncogene-positive NSCLC patients with BM, a modified Lung-molGPA index was established based on the prognostic factors with a C-index of 0.73 (95% CI: 0.68-0.80) to accurately calculate survival probability (P < 0.001).
In the era of precision medicine, Lung-molGPA accurately predicted the prognosis of NSCLC patients with mutant genotypes and BM, although it did not perform well in wild-type patients. Thus, it is worthwhile to explore the prognostic model for patients with positive driving genes.
Lung-molGPA 指数基于原始的诊断特异性预后分级评估（DS-GPA），并纳入了最近报道的基因改变数据，可预测伴脑转移（BM）的非小细胞肺癌（NSCLC）患者的结局。然而，DS-GPA 和 Lung-molGPA 的预后价值仍不确定，特别是对于不同分子类型的患者。
本研究共分析了来自中国浙江省肿瘤医院的 1184 例伴 BM 的 NSCLC 患者的临床因素和结局。所有预后因素均通过风险比进行了重要性加权。重新评估了 DS-GPA 和 Lung-molGPA 在伴 BM 和不同遗传特征的 NSCLC 患者中的适用性。此外，还为有基因变异的 NSCLC 患者开发了一种新的改良 Lung-molGPA。
本研究中 NSCLC 患者从 BM 诊断开始的中位生存时间为 14.0 个月。DS-GPA 和 Lung-molGPA 模型均能有效地预测伴 BM 的 NSCLC 患者的结局（P<0.001），且 Lung-molGPA 模型的预测更为准确。此外，Lung-molGPA 评分在有基因变异的患者中具有区分能力（P<0.001），而在野生型患者中无显著差异（P=0.133）。对于伴 BM 的携带癌基因阳性的 NSCLC 患者，根据预后因素建立了改良的 Lung-molGPA 指数，其 C 指数为 0.73（95%CI：0.68-0.80），可准确计算生存概率（P<0.001）。
在精准医学时代，Lung-molGPA 能准确预测有突变基因型和 BM 的 NSCLC 患者的预后，尽管在野生型患者中表现不佳。因此，探索携带阳性驱动基因患者的预后模型是值得的。
