Tsakonas Georgios, Kamali Caroline, De Petris Luigi, Friesland Signe, Lewensohn Rolf, Ekman Simon
Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden.
Cancers (Basel). 2020 Jul 6;12(7):1804. doi: 10.3390/cancers12071804.
Disease-specific Graded Prognostic Assessment (DS-GPA) is the most validated prognostic tool for patients with brain metastasized lung cancer. The Lung-molGPA scoring system was recently introduced for oncogenic-driven brain metastasized lung cancer, but has not yet been validated in cohorts including only ALK-translocated tumors.
We designed a retrospective cohort study consisting of 44 patients with brain metastasized ALK-positive, non-small cell lung cancer (NSCLC) who were treated between January 2009 and November 2019 at Karolinska University Hospital in Stockholm, Sweden. Information about demographics and clinicopathological parameters were collected. Predictors of overall survival (OS) were identified by Cox regression analyses. A bootstrap validation with 1000 samples was performed in order to compare the different prognostic scores.
The variables found to independently influence OS in the multivariate analysis, i.e., PS, sex and brain metastases at diagnosis, were used as prognostic variables in our new prognostic index (ALK-BPI). Patients were divided into two prognostic groups. The median OS was 65.7 months for the good prognostic group and 22.7 months for the poor prognostic group ( = 0.0068). In the univariate analysis of the different prognostic scores, ALK-BPI performed better than the others (HR = 3.6; 95% CI: 1.3-9.9). The mean C-statistics of the different prognostic scores were compared to each other, and no significant difference was observed.
We propose the ALK-BPI score as a new prognostic tool that can easily be applied for ALK-positive lung cancer patients with brain metastases in daily clinical practice, as it has at least the same prognostic value as Lung-molGPA.
疾病特异性分级预后评估（DS-GPA）是脑转移肺癌患者中最有效的预后工具。肺分子GPA评分系统最近被引入用于致癌驱动的脑转移肺癌，但尚未在仅包括ALK易位肿瘤的队列中得到验证。
我们设计了一项回顾性队列研究，纳入了2009年1月至2019年11月在瑞典斯德哥尔摩卡罗林斯卡大学医院接受治疗的44例脑转移ALK阳性非小细胞肺癌（NSCLC）患者。收集了人口统计学和临床病理参数信息。通过Cox回归分析确定总生存（OS）的预测因素。进行了1000次样本的自助验证，以比较不同的预后评分。
在多变量分析中发现独立影响OS的变量，即PS、性别和诊断时的脑转移，被用作我们新的预后指数（ALK-BPI）中的预后变量。患者被分为两个预后组。良好预后组的中位OS为65.7个月，不良预后组为22.7个月（P = 0.0068）。在不同预后评分的单变量分析中，ALK-BPI的表现优于其他评分（HR = 3.6；95%CI：1.3-9.9）。比较了不同预后评分的平均C统计量，未观察到显著差异。
我们提出ALK-BPI评分作为一种新的预后工具，在日常临床实践中可轻松应用于有脑转移的ALK阳性肺癌患者，因为它至少与肺分子GPA具有相同的预后价值。
