Morjani Moncef, Dissaux Brieg, Pradier Olivier, Querellou Solène, Seizeur Romuald, Nguyen Victor, Schick Ulrike, Lucia François, Dissaux Gurvan, Bourbonne Vincent
Radiation Oncology Department, University Hospital, Brest, France.
INSERM, GETBO UMR 1304, University of Western Brittany, Brest, France.
Neurooncol Adv. 2025 Jul 10;7(1):vdaf151. doi: 10.1093/noajnl/vdaf151. eCollection 2025 Jan-Dec.
Stereotactic radiotherapy (SRT) is the main treatment for patients with 1 to 3-5 brain metastases (BMs) but with the compromise of a higher risk of distant brain failure (DBF) in comparison with whole brain radiotherapy. Early DBF has a significant negative impact on overall survival (OS). We propose to build and validate a prediction model of early DBF.
Early DBF was defined as the appearance of unknown BMs on the first post-SRT magnetic resonance imaging (MRI). A nomogram was built for the prediction of early DBF using patients from a cohort of 537 SRT courses. The nomogram was evaluated for early DBF classification using the chi-squared test. Prediction of DBF-free survival and OS was tested using Kaplan-Meier curves and the log-rank test. The model was validated on an external cohort of 160 subsequently delivered SRT courses.
In the cohort of 537 SRT courses, early DBF occurred in 17% cases. The number of BMs and the DS-GPA score were significant predictors of early DBF. The nomogram demonstrated robust performances for early DBF classification (χ 23.7, < .0001), DBF-free survival (χ 35.5 < .0001, Figure 1), and OS (χ 38.9, < .0001). On the validation cohort, the same nomogram achieved a χ of 15.3, = .0005 for DBF-free survival and a χ of 8.6, = .01 for OS.
Our study provides a robust predictive model for early DBF, validated in an independent cohort. This nomogram could improve clinical outcomes and treatment personalization.
立体定向放射治疗（SRT）是1至3 - 5个脑转移瘤（BMs）患者的主要治疗方法，但与全脑放疗相比，存在远处脑衰竭（DBF）风险较高的问题。早期DBF对总生存期（OS）有显著负面影响。我们提议构建并验证早期DBF的预测模型。
早期DBF定义为SRT后首次磁共振成像（MRI）上出现不明BMs。使用来自537个SRT疗程队列的患者构建预测早期DBF的列线图。使用卡方检验评估列线图对早期DBF分类的效果。使用Kaplan-Meier曲线和对数秩检验测试无DBF生存期和OS的预测情况。该模型在160个随后进行的SRT疗程的外部队列中进行验证。
在537个SRT疗程队列中，17%的病例出现早期DBF。BMs数量和DS-GPA评分是早期DBF的显著预测因素。列线图在早期DBF分类（χ² 3.7，<0.0001）、无DBF生存期（χ² 35.5，<0.0001，图1）和OS（χ² 38.9，<0.0001）方面表现出强大性能。在验证队列中，相同的列线图在无DBF生存期方面的χ²为15.3，P = 0.0005，在OS方面的χ²为8.6，P = 0.01。
我们的研究提供了一个针对早期DBF的强大预测模型，并在独立队列中得到验证。该列线图可改善临床结果和治疗个性化。
