PROGNOSTIC INDICES FOR BRAIN METASTASES – WHICH BEST REFLECTS A UK COHORT AND WHAT IS THE PROGNOSIS OF OUR METASTASIS PATIENTS?

摘要

Many prognostic indices have been developed for patients with newly developed brain metastases; and have been analysed by different international groups, to find what the survival rates are for patients within different levels of each index. Our aim was to categorise our patients with brain metastasis into these indices, compare their survival to the previous analyses to find which best represented our cohort, and also to find which index best separates our patients into prognostic categories. The RTOG GPA, RPA, BSBM and diagnosis-specific GPA were assessed.METHODSAll patients who were referred, from January to June 2015, to Bristol Neuro-oncology MDT with probable diagnosis of solid intracerebral metastasis were included. Age, date of initial diagnosis, likely primary, KPS, number of intracranial metastases, status of systemic disease, management strategy and date of death. If the patients were still alive at time of data collection, their date of death was censored at 14/11/2017. Kaplan Meier survival curves were used for analysis, with Log rank tests to assess distinction between groups. A significance level of 5% was used. RESULTS 83 patients were identified, with 11 alive at the time of data collection. Median age was 67 years. Median survival was 4.9 months, with 47% surviving 6 months or more, an d28% surviving over one year. 63.9% had extracranial metastasis, with 61.4% uncontrolled disease. The most common tumour was melanoma (24.1%), then lung (22.9%) and breast (14.5%). 6% underwent biopsy, 16.9% total excision, 36.1% palliative care, and 37.3% SRS. Our data most closely fit with the prognoses of Villa et al (2011) for the RTOG GPA, RPA and BSBM. However, there was no significant difference in the survival between different levels of prognostic index.