Abstract
PurposeThe purpose of this study was to validate a new prognostic model (GI-GPA) originally derived from a multi-center database (USA, Canada, Japan).Patients and MethodsThis retrospective study included 92 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. The GI-GPA score was calculated as described by Sperduto et al.ResultsMedian survival was 4 months. The corresponding figures for the 4 different prognostic strata were 2.3, 4.4, 9.4 and 12.7 months, respectively (p = 0.0001). Patients whose management included surgical resection had longer median survival than those who were treated with other approaches (median 11.9 versus 3.0 months, p = 0.002). Comparable results were seen for additional systemic therapy (median 8.5 versus 3.5 months, p = 0.01).ConclusionThese results confirm the validity of the GI-GPA in an independent dataset from a different geographical region, despite the fact that overall survival was shorter in all prognostic strata, compared to Sperduto et al. Potential explanations include differences in molecular tumor characteristics and treatment selection, both brain metastases-directed and extracranially. Long-term survival beyond 5 years is possible in a small minority of patients.
Highlights
According to recent data, survival of patients with brain metastases from gastrointestinal cancers has improved [1]
Prognosis and eligibility for different treatment options varies with performance status, number of brain metastases and patterns of extracranial disease extent [2,3,4,5,6,7]
Models such as the graded prognostic assessment (GPA) [12, 13] have been validated in several studies and adopted by many clinicians. These tools have been updated to further refine their performance [14,15,16]. This is true for the GPA for gastrointestinal primary tumors (GI-GPA) [1]
Summary
Survival of patients with brain metastases from gastrointestinal cancers has improved [1]. Prognostic scores have long been used to support decision making and to stratify patients for research purposes [10, 11] Models such as the graded prognostic assessment (GPA) [12, 13] have been validated in several studies and adopted by many clinicians. These tools have been updated to further refine their performance [14,15,16]. This is true for the GPA for gastrointestinal primary tumors (GI-GPA) [1] The latter 4-tiered score is based on Karnofsky performance status (KPS), age (cut-off 60 years), number of brain metastases and presence of extracranial metastases, while its predecessor solely reflected variations in KPS. The purpose of the present study was to validate the GI-GPA in an independent cohort of patients from Germany and Norway, hypothesizing that a validated score would gain wide acceptance
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