Department of Neurology, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Cancer Med. 2023 Jun;12(11):12316-12324. doi: 10.1002/cam4.5928. Epub 2023 Apr 11.
Established models for prognostic assessment in patients with brain metastasis do not stratify for prior surgery. Here we tested the prognostic accuracy of the Graded Prognostic Assessment (GPA) score model in patients operated for BM and explored further prognostic factors.
We included 285 patients operated for brain metastasis at the University Hospital Zurich in the analysis. Information on patient characteristics, imaging, staging, peri- and postoperative complications and survival were extracted from the files and integrated into a multivariate Cox hazard model.
The GPA score showed an association with outcome. We further identified residual tumor after surgery (p = 0.007, hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.1-2.3) steroid use (p = 0.021, HR 1.7, 95% CI 1.1-2.6) and number of extracranial metastasis sites (p = 0.009, HR 1.4, 95% CI 1.1-1.6) at the time of surgery as independent prognostic factors. A trend was observed for postoperative infection of the subarachnoid space (p = 0.102, HR 3.5, 95% CI 0.8-15.7).
We confirm the prognostic capacity of the GPA score in a cohort of operated patients with brain metastasis. However, extent of resection and steroid use provide additional aid for the prognostic assessment in these patients.
现有的脑转移瘤患者预后评估模型并未对既往手术进行分层。在此，我们测试了改良预后评分（GPA）模型在接受脑转移瘤手术患者中的预后准确性，并进一步探讨了预后因素。
我们分析了苏黎世大学医院 285 例接受脑转移瘤手术的患者。从档案中提取患者特征、影像学、分期、围手术期并发症和生存信息，并整合到多变量 Cox 风险模型中。
GPA 评分与预后相关。我们进一步确定了术后残余肿瘤（p=0.007，风险比（HR）1.6，95%置信区间（CI）1.1-2.3）、类固醇使用（p=0.021，HR 1.7，95% CI 1.1-2.6）和手术时颅外转移灶数目（p=0.009，HR 1.4，95% CI 1.1-1.6）是独立的预后因素。术后蛛网膜下腔感染有趋势（p=0.102，HR 3.5，95% CI 0.8-15.7）。
我们在接受脑转移瘤手术的患者队列中证实了 GPA 评分的预后能力。然而，切除范围和类固醇的使用为这些患者的预后评估提供了额外的帮助。
