Abstract
Impaired heart rate variability (HRV) has been demonstrated as a negative survival prognosticator in various diseases. We conducted this prospective study to evaluate how HRV affects brain metastasis (BM) patients. Fifty-one BM patients who had not undergone previous brain operation or radiotherapy (RT) were recruited from January 2010 to July 2012, and 40 patients were included in the final analysis. A 5-minute electrocardiogram was obtained before whole brain radiotherapy. Time domain indices of HRV were compared with other clinical factors on overall survival (OS). In the univariate analysis, Karnofsky performance status (KPS) <70 (P = 0.002) and standard deviation of the normal-to-normal interval (SDNN) <10 ms (P = 0.004) significantly predict poor survival. The multivariate analysis revealed that KPS <70 and SDNN <10 ms were independent negative prognosticators for survival in BM patients with hazard ratios of 2.657 and 2.204, respectively. In conclusion, HRV is associated with survival and may be a novel prognostic factor for BM patients.
Highlights
Brain metastasis (BM) is the most common intracranial malignancy, developing in 20%–40% of all cancer patients during the course of the disease
Based on the recursive partitioning analysis (RPA), patients are classified into 3 categories: RPA I includes patients who are
NSCLC: Nonsmall cell lung cancer, SCLC: small cell lung cancer, BM at diagnosis: brain metastases confirmed at primary diagnosis, KPS: Karnofsky performance status, and RPA: recursive partitioning analysis
Summary
Brain metastasis (BM) is the most common intracranial malignancy, developing in 20%–40% of all cancer patients during the course of the disease. Since 1997, several prognostic indices have been proposed, assessing the number of metastatic brain lesions, the largest intracranial lesion size, and the systemic disease status [4,5,6]. These prognostic indices are widely used in clinical settings, substantial proportion of erroneous survival prediction exists, for example, those reported by Nieder and Molls and Villaet al. Impaired HRV has been correlated with a short survival time and is a poor prognosticator in patients with advanced cancer [16, 18, 19]. Based on the need for a novel prognosticator of BM patients survival, and the significant relationship between HRV and cancer survival, we conducted this prospective study to evaluate the hypothesis that time domain HRV indices are associated with survival and can be used as a prognostic factor in BM patients
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