Anna S Berghoff1, Fabian Wolpert1, Tim Holland-Letz1, Romina Koller1, Georg Widhalm1, Brigitte Gatterbauer1, Karin Dieckmann1, Peter Birner1, Rupert Bartsch1, Christoph C Zielinski1, Michael Weller1, Matthias Preusser1. 1. Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland; Biostatistics Division, German Cancer Research Center, Heidelberg, Germany; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Department of Radiotherapy, Medical University of Vienna, Vienna, Austria; Department of Pathology, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: We aimed to investigate the potential of standard hematologic and serum biochemical parameters to provide an independent and substantial contribution to the prediction of survival in patients with newly diagnosed brain metastases (BM). METHODS: Hemoglobin, white blood cell count, platelet count, serum albumin, creatinine, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were assessed at diagnosis of BM in a discovery cohort of 1200 cancer patients. A multivariable Cox regression model was used to derive the LabBM score. The LabBM score was externally validated in an independent cohort consisting of 366 patients. RESULTS: Hemoglobin below lower limit of normal (<LLN; hazard ratio [HR] 1.28; P = .001), platelet count <LLN (HR: 1.36; P = .013), albumin <LLN (HR: 1.19; P = .038), LDH above upper limit of normal (>ULN; HR: 1.51; P < .001), and CRP >ULN (HR: 1.52; P < .001) were associated with survival in a multivariable Cox regression model and were included in the calculation of the LabBM score. Multivariable analysis including the LabBM score and graded prognostic assessment class revealed an independent and significant association of the LabBM score with overall survival (OS) (HR: 1.42; 95% CI: 1.29-1.57; P < .001). The strong and independent association of LabBM score (HR: 1.93; 95% CI: 1.54-2.42) with OS prognosis was confirmed in the validation cohort. CONCLUSION: Standard clinical blood parameters, combined in the easy-to-calculate LabBM score, provide strong and independent prognostic information in patients with BM. The LabBM score is an objective, inexpensive, and reproducible tool to plan clinical management strategies in BM patients and to improve patient selection and stratification for clinical trials.
BACKGROUND: We aimed to investigate the potential of standard hematologic and serum biochemical parameters to provide an independent and substantial contribution to the prediction of survival in patients with newly diagnosed brain metastases (BM). METHODS: Hemoglobin, white blood cell count, platelet count, serum albumin, creatinine, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were assessed at diagnosis of BM in a discovery cohort of 1200 cancer patients. A multivariable Cox regression model was used to derive the LabBM score. The LabBM score was externally validated in an independent cohort consisting of 366 patients. RESULTS: Hemoglobin below lower limit of normal (<LLN; hazard ratio [HR] 1.28; P = .001), platelet count <LLN (HR: 1.36; P = .013), albumin <LLN (HR: 1.19; P = .038), LDH above upper limit of normal (>ULN; HR: 1.51; P < .001), and CRP >ULN (HR: 1.52; P < .001) were associated with survival in a multivariable Cox regression model and were included in the calculation of the LabBM score. Multivariable analysis including the LabBM score and graded prognostic assessment class revealed an independent and significant association of the LabBM score with overall survival (OS) (HR: 1.42; 95% CI: 1.29-1.57; P < .001). The strong and independent association of LabBM score (HR: 1.93; 95% CI: 1.54-2.42) with OS prognosis was confirmed in the validation cohort. CONCLUSION: Standard clinical blood parameters, combined in the easy-to-calculate LabBM score, provide strong and independent prognostic information in patients with BM. The LabBM score is an objective, inexpensive, and reproducible tool to plan clinical management strategies in BM patients and to improve patient selection and stratification for clinical trials.
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