Rades Dirk, Delikanli Cansu, Schild Steven E, Kristiansen Charlotte, Tvilsted Søren, Janssen Stefan
Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany.
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.
Biology (Basel). 2022 Sep 30;11(10):1434. doi: 10.3390/biology11101434.
Survival scores facilitate personalized cancer treatment. Due to demographic changes, very elderly patients are more prevalent than in the past. A score was developed in 94 patients aged ≥ 80 years undergoing whole-brain radiotherapy for brain metastases. Dose fractionation, treatment period, age, sex, performance score (ECOG-PS), tumor type, count of lesions, metastases outside the brain, and interval tumor diagnosis to radiotherapy were retrospectively evaluated. Independent predictors of survival were used for the score. Based on individual scoring points obtained from 3-month survival rates, prognostic groups were designed. Additionally, the score was compared to an existing tool developed in patients ≥ 65 years. ECOG-PS, count of lesions, and extra-cranial metastases were independent prognostic factors. Three groups were created (7, 10, and 13−16 points) with 3-month survival of 6%, 25%, and 67% (p < 0.001), respectively. Positive predictive values (PPVs) regarding death ≤ 3 and survival ≥ 3 months were 94% and 67% (new score) vs. 96% and 48% (existing tool), respectively. PPVs for survival ≥1 and ≥2 months were 88% and 79% vs. 63% and 58%, respectively. Both tools were accurate in predicting death ≤2, ≤3, and ≤6 months. The new score was more precise regarding death ≤1 month and survival (all time periods) and appeared preferable. However, it still needs to be validated.
生存评分有助于癌症的个性化治疗。由于人口结构的变化，高龄患者比过去更为普遍。对94例年龄≥80岁接受脑转移瘤全脑放疗的患者制定了一个评分系统。对剂量分割、治疗周期、年龄、性别、体能状态评分（ECOG-PS）、肿瘤类型、病灶数量、脑外转移以及肿瘤诊断至放疗的间隔时间进行了回顾性评估。将生存的独立预测因素用于该评分系统。根据从3个月生存率获得的个体评分点，设计了预后分组。此外，将该评分与一个针对≥65岁患者开发的现有工具进行了比较。ECOG-PS、病灶数量和颅外转移是独立的预后因素。创建了三组（7分、10分和13 - 16分），3个月生存率分别为6%、25%和67%（p < 0.001）。关于死亡≤3个月和生存≥3个月的阳性预测值（PPV），新评分分别为94%和67%，而现有工具分别为96%和48%。生存≥1个月和≥2个月的PPV分别为88%和79%，而现有工具分别为63%和58%。两种工具在预测死亡≤2个月、≤3个月和≤6个月方面都很准确。新评分在预测死亡≤1个月和生存（所有时间段）方面更精确，似乎更具优势。然而，它仍需进行验证。
