Tuberc Respir Dis.  2012 Jan;72(1):15-23.

Prognostic Factors and Scoring Systems for Non-Small Cell Lung Cancer Patients Harboring Brain Metastases Treated with Gamma Knife Radiosurgery

• Eom JS
• Cho EJ
• Baek DH
• Lee KN
• Shin K
• Kim MH
• Lee K
• Kim KU
• Park HK
• Kim YS
• Park SK
• Cha SH
• Lee MK

Abstract

BACKGROUND
The survival of non-small cell lung cancer (NSCLC) patients with brain metastases is reported to be 3~6 months even with aggressive treatment. Some patients have very short survival after aggressive treatment and reliable prognostic scoring systems for patients with cancer have a strong correlation with outcome, often supporting decision making and treatment recommendations.
METHODS
A total of one hundred twenty two NSCLC patients with brain metastases who received gamma knife radiosurgery (GKRS) were analyzed. Survival analysis was calculated in all patients for thirteen available prognostic factors and four prognostic scoring systems: score index for radiosurgery (SIR), recursive partitioning analysis (RPA), graded prognostic assessment (GPA), and basic score for brain metastases (BSBM).
RESULTS
Age, Karnofsky performance status, largest brain lesion volume, systemic chemotherapy, primary tumor control, and medication of epidermal growth factor receptor tyrosine kinase inhibitor were statistically independent prognostic factors for survival. A multivariate model of SIR and RPA identified significant differences between each group of scores. We found that three-tiered indices such as SIR and RPA are more useful than four-tiered scoring systems (GPA and BSBM).
CONCLUSION
There is little value of RPA class III (most unfavorable group) for the same results of 6-month and 1-year survival rate. Thus, SIR is the most useful index to sort out patients with poorer prognosis. Further prospective trials should be performed to develop a new molecular- and gene-based prognostic index model.

Keyword

Carcinoma, Non-Small-Cell Lung; Neoplasm Metastasis; Brain; Radiosurgery; Prognosis

MeSH Terms

Brain
Carcinoma, Non-Small-Cell Lung
Decision Making
Humans
Karnofsky Performance Status
Neoplasm Metastasis
Outpatients
Prognosis
Protein-Tyrosine Kinases
Radiosurgery
Receptor, Epidermal Growth Factor
Survival Rate
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor

Figure

• 

  Figure 1 Kaplan-Meier survival curves for prognostic scoring systems. (A) SIR provided the most accurate prediction on survival after GKRS. (B) There was little value of RPA class III on survival model for the same results from 6 month survival rate and 1 year survival rate. (C) GPA scoring system revealed statistical differencse only in class I vs. class IV and class III vs. class IV and there were no significant differences between other classes. (D) The survival curves of BSBM were grouped with class I~II and class III~IV. There was a statistical difference in BSBM class I~II vs. class III~IV. SIR: score index for radiosurgery; RPA: recursive partitioning analysis; GPA: graded prognostic assessment; BSBM: basic score for brain metastases; MST: median survival time; 6 MSR: 6-month survival rate; 1 YSR: 1-year survival rate.

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