Prospective validation of the new graded prognostic assessment scale for brain metastases: A multicenter study.

Abstract

2074 Background: Prognostic indexes are useful to guide tailored treatment strategies for cancer patients (pts) with brain metastasis (BM). We evaluated the new Graded Prognostic Assessment (GPA) scale in a prospective validation study. Methods: A total of 285 BM (n = 85 with synchronous BM) pts, accrued between 2000 and 2009, were included in this analysis. Median age was 60.1 ± 12.0 years. The median KPS and number of BM was 70 and 3, respectively. The majority of primary tumours were lung (53%), or breast (17%) cancers. Twenty-eight percent of the cohort had no extracranial metastasis (ECrM). Forty percent and 44% of patients presented with stable and progressive disease, respectively. NED was found in another 16% of patients. Treatment was administered to 255 (89.5%) patients. Only a minority of patients could be classified prospectively in a favourable prognostic class: GPA 3.5-4: 3.9%; recursive partitioning analysis (RPA) 1, 8.4% and Basic Score for BM (BSBM) 3, 9.1%. Median follow-up (FU) was 5.2 ± 4.7 months. Results: During the period of FU, 225 (78.9%) patients died. The 6 months- and 1 year-OS was 36.9% and 17.6%, respectively. On univariate analysis, improved OS was found to be significantly associated with KPS (p < 0.001), GPA (p < 0.001), RPA (p < 0.001), BSBM (p < 0.001), treatment (p < 0.001), no ECrM (p = 0.004), control of the primary tumor (p = 0.009), number of BM (≤ 3 vs. > 3; p = 0.017) and type of primary cancer (p = 0.034). On multivariate analysis, only treatment (p < 0.001), RPA (p = 0.002), GPA (p = 0.004) and BSBM (p = 0.03) retained statistical significance. Conclusions: Our data suggest that the new GPA index is as prognostic as the RPA scale. This score avoids systemic disease status evaluation. No significant financial relationships to disclose.