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Use of the Graded Prognostic Assessment (GPA) score in patients with brain metastases from primary tumours not represented in the diagnosis-specific GPA studies

Nutzen des Graded-Prognostic-Assessment-Scores bei Patienten mit Hirnmetastasen von nicht in den diagnosespezifischen GPA-Studien repräsentierten Primärtumoren

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Abstract

Background and purpose

Assessment of prognostic factors might influence treatment decisions in patients with brain metastases. Based on large studies, the diagnosis-specific graded prognostic assessment (GPA) score is a useful tool. However, patients with unknown or rare primary tumours are not represented in this model. A pragmatic approach might be use of the first GPA version which is not limited to specific primary tumours.

Patients and methods

This retrospective analysis examines for the first time whether the GPA is a valid score in patients not eligible for the diagnosis-specific GPA. It includes 71 patients with unknown primary tumour, bladder cancer, ovarian cancer, thyroid cancer or other uncommon primaries. Survival was evaluated in uni- and multivariate tests.

Results

The GPA significantly predicted survival. Moreover, improved survival was seen in patients treated with surgical resection or radiosurgery (SRS) for brain metastases. The older recursive partitioning analysis (RPA) score was significant in univariate analysis. However, the multivariate model with RPA, GPA and surgery or SRS versus none showed that only GPA and type of treatment were independent predictors of survival.

Conclusion

Ideally, cooperative research efforts would lead to development of diagnosis-specific scores also for patients with rare or unknown primary tumours. In the meantime, a pragmatic approach of using the general GPA score appears reasonable.

Hintergrund und Ziel

Die Einschätzung prognostischer Faktoren kann die Wahl der Behandlung bei Patienten mit Hirnmetastasen beeinflussen. Der diagnosespezifische Graded-Prognostic-Assessment(GPA)-Score ist in großen Studien als nützliches Instrument bestätigt worden. Bestimmte seltene Primärtumoren oder unbekannte Primärtumoren sind jedoch nicht in diesem Modell abgebildet. Ein Einsatz der ursprünglichen, nicht auf bestimmte Primärtumoren limitierten GPA-Version (Tab. 1) wäre hier ein pragmatisches Vorgehen.

Patienten und Methoden

Die vorliegende retrospektive Studie untersucht erstmals, ob der ursprüngliche GPA-Score ein valides Instrument für Patienten ist, deren Erkrankung im diagnosespezifischen GPA-Score nicht abgebildet wird. Es wurden 71 Patienten mit unbekanntem Primärtumor, Blasenkarzinom, Ovarialkarzinom, Schilddrüsenkarzinom und anderen selteneren Primärtumoren inkludiert (Tab. 2). Das Überleben wurde mittels uni- und multivariater Tests evaluiert.

Ergebnisse

GPA war signifikant mit dem Überleben assoziiert (Fig. 1). Patienten, die mit Radiochirurgie oder Resektion der Hirnmetastasen behandelt worden waren, hatten ebenfalls ein längeres Überleben. Der ältere Recursive-Partitioning-Analysis(RPA)-Score war in der univariaten Analyse signifikant. Das multivariate Modell mit RPA, GPA und Radiochirurgie oder Resektion versus keine Radiochirurgie oder Resektion zeigte, dass nur die Art der Behandlung und der GPA-Score unabhängige Prognosefaktoren waren.

Schlussfolgerung

Im Idealfall würden auch für Patienten mit seltenem oder unbekanntem Primärtumor in Kooperation verschiedener Forschungsgruppen diagnosespezifische Scores entwickelt werden. Währenddessen kann im Sinne eines pragmatischen Vorgehens der ursprüngliche GPA-Score verwendet werden.

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Fig. 1

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway

    C. Nieder

  2. Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway

    C. Nieder

  3. Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany

    N.H. Andratschke

  4. Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    H. Geinitz

  5. Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany

    A.L. Grosu

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  1. C. Nieder
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  2. N.H. Andratschke
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  3. H. Geinitz
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  4. A.L. Grosu
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Correspondence to C. Nieder.

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Nieder, C., Andratschke, N., Geinitz, H. et al. Use of the Graded Prognostic Assessment (GPA) score in patients with brain metastases from primary tumours not represented in the diagnosis-specific GPA studies. Strahlenther Onkol 188, 692–695 (2012). https://doi.org/10.1007/s00066-012-0107-2

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  • DOI: https://doi.org/10.1007/s00066-012-0107-2

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