Dept. of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Radiother Oncol. 2023 Dec;189:109917. doi: 10.1016/j.radonc.2023.109917. Epub 2023 Sep 22.
Brain metastasis velocity (BMV) has been proposed as a prognostic factor for overall survival (OS) in patients with brain metastases (BMs). In this study, we conducted an external validation and comparative assessment of the performance of all three BMV scores.
Patients treated with intracranial stereotactic radiotherapy (SRT) for BM at a single center between 2014 and 2018 were identified. Where possible, all three BMV scores were calculated. Log-rank tests and linear, logistic and Cox regression analysis were used for validation and predictor identification of OS.
For 333 of 384 brain metastasis patients, at least one BMV score could be calculated. In a sub-group of 187 patients, "classic" BMV was validated as categorical (p < 0.0001) and continuous variable (HR 1.02; 95% CI 1.02-1.03; p < 0.0001). In a sub-group of 284 patients, "initial" BMV was validated as categorical variable (high-risk vs. low-risk; p < 0.01), but not as continuous variable (HR 1.02; 95% CI 0.99-1.04; p = 0.224). "Volume-based" BMV could not be validated in a sub-group of 104 patients. On multivariable Cox regression analysis, iBMV (HR 1.85; 95% CI 1.01-3.38; p < 0.05) and cBMV (HR 2.32; 95% CI 1.15 4.68; p < 0.05) were predictors for OS for intermediate-risk patients after first SRT and first DBFs, respectively. cBMV proved to be the dominant predictor for OS for high-risk patients (HR 2.99; 95% CI 1.30-6.91; p < 0.05).
This study externally validated cBMV and iBMV as prognostic scores for OS in patients treated with SRT for BMs whereas validation of vBMV was not achieved.
脑转移瘤生长速度（BMV）已被提出作为脑转移瘤（BM）患者总生存期（OS）的预后因素。在这项研究中，我们对所有三种 BMV 评分进行了外部验证和性能比较评估。
在 2014 年至 2018 年间，在一家单中心接受颅内立体定向放射治疗（SRT）治疗 BM 的患者被确定。在可能的情况下，计算了所有三种 BMV 评分。对数秩检验和线性、逻辑和 Cox 回归分析用于验证和识别 OS 的预测因素。
在 384 例脑转移瘤患者中，有 333 例至少计算了一个 BMV 评分。在 187 例患者的亚组中，“经典”BMV 被验证为分类变量（p<0.0001）和连续变量（HR 1.02；95%CI 1.02-1.03；p<0.0001）。在 284 例患者的亚组中，“初始”BMV 被验证为分类变量（高风险与低风险；p<0.01），但不是连续变量（HR 1.02；95%CI 0.99-1.04；p=0.224）。在 104 例患者的亚组中，“基于体积”的 BMV 无法验证。多变量 Cox 回归分析显示，iBMV（HR 1.85；95%CI 1.01-3.38；p<0.05）和 cBMV（HR 2.32；95%CI 1.15-4.68；p<0.05）分别是接受首次 SRT 和首次 DBFs 治疗的中危患者 OS 的预测因素。对于高危患者，cBMV 被证明是 OS 的主要预测因素（HR 2.99；95%CI 1.30-6.91；p<0.05）。
本研究对外验证了 cBMV 和 iBMV 作为 SRT 治疗 BM 患者 OS 的预后评分，而 vBMV 的验证未成功。
