Paul W Sperduto1, Brian J Deegan2, Jing Li2, Krishan R Jethwa3, Paul D Brown3, Natalie Lockney4, Kathryn Beal4, Nitesh G Rana5, Albert Attia5, Chia-Lin Tseng6, Arjun Sahgal6, Ryan Shanley7, William A Sperduto8, Emil Lou8, Amir Zahra9, John M Buatti9, James B Yu10, Veronica Chiang11, Jason K Molitoris12, Laura Masucci13, David Roberge13, Diana D Shi14, Helen A Shih14, Adam Olson15, John P Kirkpatrick15, Steve Braunstein16, Penny Sneed16, Minesh P Mehta17. 1. Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota. 2. MD Anderson Cancer Center, Department of Radiation Oncology, Houston, Texas. 3. Mayo Clinic, Department of Radiation Oncology, Rochester, Minnesota. 4. Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, New York. 5. Vanderbilt University, Department of Radiation Oncology, Nashville, Tennessee. 6. Sunnybrook-University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada. 7. University of Minnesota Biostatistics, Minneapolis, Minnesota. 8. University of Minnesota Cancer Center, Department of Medical Oncology, Minneapolis, Minnesota. 9. University of Iowa, Department of Radiation Oncology, Iowa City, Iowa. 10. Yale University, Department of Radiation Oncology, New Haven, Connecticut. 11. Yale University, Department of Neurosurgery, New Haven, Connecticut. 12. University of Maryland, Department of Radiation Oncology, Baltimore, Maryland. 13. Centre Hospitalier de l' Université de Montreal, Department of Radiation Oncology, Montreal, Quebec, Canada. 14. Massachusetts General Hospital, Department of Radiation Oncology, Boston, Massachusetts. 15. Duke University, Department of Radiation Oncology, Durham, North Carolina. 16. University of California San Francisco, Department of Radiation Oncology, San Francisco, California. 17. Miami Cancer Institute, Department of Radiation Oncology, Miami, Florida.
Abstract
Background: Brain metastases are a common complication of renal cell carcinoma (RCC). Our group previously published the Renal Graded Prognostic Assessment (GPA) tool. In our prior RCC study (n = 286, 1985-2005), we found marked heterogeneity and variation in outcomes. In our recent update in a larger, more contemporary cohort, we identified additional significant prognostic factors. The purpose of this study is to update the original Renal-GPA based on the newly identified prognostic factors. Methods: A multi-institutional retrospective institutional review board-approved database of 711 RCC patients with new brain metastases diagnosed from January 1, 2006 to December 31, 2015 was created. Clinical parameters and treatment were correlated with survival. A revised Renal GPA index was designed by weighting the most significant factors in proportion to their hazard ratios and assigning scores such that the patients with the best and worst prognoses would have a GPA of 4.0 and 0.0, respectively. Results: The 4 most significant factors were Karnofsky performance status, number of brain metastases, extracranial metastases, and hemoglobin. The overall median survival was 12 months. Median survival for GPA groups 0-1.0, 1.5-2.0, 2.5-3, and 3.5-4.0 (% n = 25, 27, 30 and 17) was 4, 12, 17, and 35 months, respectively. Conclusion: The updated Renal GPA is a user-friendly tool that will help clinicians and patients better understand prognosis, individualize clinical decision making and treatment selection, provide a means to compare retrospective literature, and provide more robust stratification of future clinical trials in this heterogeneous population. To simplify use of this tool in daily practice, a free online application is available at brainmetgpa.com.
Background: Brain metastases are a common complication of renal cell carcinoma (RCC). Our group previously published the Renal Graded Prognostic Assessment (GPA) tool. In our prior RCC study (n = 286, 1985-2005), we found marked heterogeneity and variation in outcomes. In our recent update in a larger, more contemporary cohort, we identified additional significant prognostic factors. The purpose of this study is to update the original Renal-GPA based on the newly identified prognostic factors. Methods: A multi-institutional retrospective institutional review board-approved database of 711 RCCpatients with new brain metastases diagnosed from January 1, 2006 to December 31, 2015 was created. Clinical parameters and treatment were correlated with survival. A revised Renal GPA index was designed by weighting the most significant factors in proportion to their hazard ratios and assigning scores such that the patients with the best and worst prognoses would have a GPA of 4.0 and 0.0, respectively. Results: The 4 most significant factors were Karnofsky performance status, number of brain metastases, extracranial metastases, and hemoglobin. The overall median survival was 12 months. Median survival for GPA groups 0-1.0, 1.5-2.0, 2.5-3, and 3.5-4.0 (% n = 25, 27, 30 and 17) was 4, 12, 17, and 35 months, respectively. Conclusion: The updated Renal GPA is a user-friendly tool that will help clinicians and patients better understand prognosis, individualize clinical decision making and treatment selection, provide a means to compare retrospective literature, and provide more robust stratification of future clinical trials in this heterogeneous population. To simplify use of this tool in daily practice, a free online application is available at brainmetgpa.com.
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