Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø.
Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Am J Clin Oncol. 2021 Feb 1;44(2):53-57. doi: 10.1097/COC.0000000000000784.
The objective of this study were to improve the 3-tiered, purely biomarker-based LabBM score, which predicts the survival of patients with brain metastases, by adding the well-established prognostic factor performance status (PS), and to define its role in comparison with the recently proposed Extracranial-Graded Prognostic Assessment score, which is based on the well-known Diagnosis-specific Graded Prognostic Assessment and 2 of the same biomarkers.
This was a retrospective single-institution analysis of 212 patients, managed with upfront brain irradiation. Survival was stratified by LabBM and LabPS score. Each included serum hemoglobin, platelets, albumin, C-reactive protein, and lactate dehydrogenase (plus PS for the LabPS). Zero, 0.5, or 1 point was assigned and the final point sum calculated. A higher point sum indicates shorter survival.
The new LabPS score predicted overall survival very well (median: 12.1 to 0.7 mo, 1-y rate: 52% to 0%), P=0.0001. However, the group with the poorest prognosis (3 or 3.5 points) was very small (4%). Most patients with comparably short survival had a lower point sum. The LabPS score failed to outperform the recently proposed Extracranial-Graded Prognostic Assessment score.
Integration of blood biomarkers should be considered when attempting to develop improved scores. Additional research is needed to improve the tools which predict short survival, because many of these patients continue to go undetected with all available scores.
本研究旨在改进基于 3 层、纯生物标志物的 LabBM 评分，该评分可预测脑转移患者的生存情况，方法是加入已确立的预后因素表现状态（PS），并与最近提出的基于广泛应用的诊断特异性分级预后评估（Diagnosis-specific Graded Prognostic Assessment，DS-GPA）和相同的 2 种生物标志物的 Extracranial-Graded Prognostic Assessment（Ex-GPA）评分进行比较。
这是一项回顾性单机构分析，共纳入 212 例接受初始脑部放疗的患者。采用 LabBM 和 LabPS 评分对生存情况进行分层。每个评分都包含血清血红蛋白、血小板、白蛋白、C 反应蛋白和乳酸脱氢酶（LabPS 还包含 PS）。赋值 0、0.5 或 1 分，并计算最终得分总和。得分越高，生存时间越短。
新的 LabPS 评分能很好地预测总生存期（中位数：12.1 至 0.7 个月，1 年生存率：52%至 0%），P=0.0001。然而，预后最差的（3 或 3.5 分）组患者人数很少（4%）。大多数生存时间较短的患者得分总和较低。LabPS 评分未能优于最近提出的 Ex-GPA 评分。
在尝试开发改良评分时，应考虑纳入血液生物标志物。需要进一步研究来改进预测短期生存的工具，因为这些患者中有许多人仍未被所有现有评分发现。
