Mir Amaan Ali1, Brian R Hirshman1, Bayard Wilson1, Alexander J Schupper1, Rushikesh Joshi1, James A Proudfoot2, Steven J Goetsch3, John F Alksne3, Kenneth Ott3, Hitoshi Aiyama4, Osamu Nagano5, Bob S Carter1, Veronica Chiang6, Toru Serizawa7, Masaaki Yamamoto4, Clark C Chen8. 1. Center for Translational and Applied Neuro-Oncology, Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA. 2. Clinical and Translational Research Institute, University of California San Diego, San Diego, California, USA. 3. San Diego Gamma Knife Center, La Jolla, California, USA. 4. Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan. 5. Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan. 6. Department of Neurosurgery, Yale University School of Medicine, and Yale Cancer Center, New Haven, Connecticut, USA. 7. Tsukiji Neurological Clinic, Tokyo Gamma Unit Center, Tokyo, Japan. 8. Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: ccchen@umn.edu.
Abstract
BACKGROUND: We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of a disease-specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). METHODS: Patient and tumor characteristics were collected from RCC cohorts with new BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. RESULTS: In univariable logistic regression models, CITV, KPS, and the number of BM were independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P = 0.042). The incorporation of the CITV into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI >0 of 0.3156 (95% confidence interval [CI], 0.0883-0.5428; P = 0.0065) and IDI of 0.0151 (95% CI, 0.0036-0.0277; P = 0.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. CONCLUSION: CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV.
BACKGROUND: We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of a disease-specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). METHODS:Patient and tumor characteristics were collected from RCC cohorts with new BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCCds-GPA. RESULTS: In univariable logistic regression models, CITV, KPS, and the number of BM were independently associated with RCCpatient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P = 0.042). The incorporation of the CITV into the RCCds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI >0 of 0.3156 (95% confidence interval [CI], 0.0883-0.5428; P = 0.0065) and IDI of 0.0151 (95% CI, 0.0036-0.0277; P = 0.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. CONCLUSION:CITV is an important prognostic variable in SRS-treated RCCpatients with BM. The prognostic value of the ds-GPA scale for RCCbrain metastasis was enhanced by the incorporation of CITV.
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