Artikel
Re-evaluation of the score index for radiosurgery (SIR), the graded prognostic assessment (GPA) and the recursive partitioning analysis (RPA) based on patients with surgical treatment of cerebral metastases
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Autoren
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Christina Wolfert
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Score Index for Radiosurgery (SIR), the graded prognostic assessment (GPA) and the Recursive Partitioning Analysis (RPA) are used for identifying patients with longer and shorter overall survival (OS). Major parameters in SIR and GPA are age, Karnofsky-performance scale (KPS), systemic disease status, number and volume of the metastasis, whereas KPS is the dominant parameter in RPA. However, it is still not known if these scores remain valid in patients undergoing surgical removal of one or more metastases. Our aim was to reevaluate SIR, RPA and GPA in patients undergoing surgery for brain metastases.
Methods: Patients who underwent resection of one (or more) brain metastases between 06/2013 to 11/2015 were prospectively included. OS (in weeks) was documented in all patients. SIR and GPA was assessed and grouped into 4 classes (SIR: class I: 1-3, class II: 4, class III: 5-7 and class IV: 8-10 points; GPA: class I: 0-1, class II: 1.5-2, class III: 2.5-3, class IV: 3.5-4 points). RPA was assessed and grouped into 3 classes. Higher classes in RPA and lower classes in SIR and GPA are related to shorter OS.
Results: We included 175 patients (80 f, 45.7%). Mean age 64 years (SD: 9.9). KPS at the time of inclusion was 82.1 on average (SD: 16.4). 84 (48%) patients had one cerebral lesion, while 60 (34%) had 3 or more metastases. Mean survival and 95%Cl stratified by scoring system category were: RPA class I : 67.2 (95% 46.9 – 87.4), class II: 53.2 (95% 40.2 – 66.0), class III: 45.4 (95%: 28.3 – 62.5); SIR class I: 50.3 (95% 37.1-63.5), class II: 66.2 (95% 43.9 – 88.4), class III: 49.6 (95% 35.4 – 63.7), class IV: 106.4 (95% 53.9-158.8); GPA class I: 52.4 (95% 31.6- 73.0), class II: 44.5 (32 – 57), class III: 70.6 (95% 50.7-90.5), class IV: 91.6 (50.4-132.7).
Conclusion: All three used scores correlate with overall survival in patients undergoing surgery for cerebral metastases. They seem to be as valid as in patients with radiosurgery. We advocate the prospective evaluation of these scores to assess their prognostic value with a higher level of evidence.
