Cumulative intracranial tumor volume augments the prognostic value of the diagnosis-specific graded prognostic assessment model for survival in patients with melanoma cerebral metastases

Brian R. Hirshman, Bayard R. Wilson, Mir Amaan Ali, Alexander J. Schupper, James A. Proudfoot, Steven J. Goetsch, Bob S. Carter, Georges Sinclair, Jiri Bartek, Veronica Chiang, Gerald Fogarty, Angela Hong, Clark C Chen

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

BACKGROUND: The diagnosis-specific graded prognostic assessment scale (ds-GPA) for patients with melanoma brain metastasis (BM) utilizes only 2 key prognostic variables: Karnofsky performance status and the number of intracranial metastases. We wished to determine whether inclusion of cumulative intracranial tumor volume (CITV) into the ds-GPA model for melanoma augmented its prognostic value. OBJECTIVE: To determine whether or not CITV augments the ds-GPA prognostic scale for melanoma. METHODS: We analyzed the survival pattern of 344 melanoma patients with BM treated with stereotactic radiosurgery (SRS) at separate institutions and validated our findings in an independent cohort of 201 patients. The prognostic value of ds-GPA for melanoma was quantitatively compared with and without the addition of CITV using the net reclassification index (NRI > 0) and integrated discrimination improvement (IDI) metrics. RESULTS: The incorporation of CITV into the melanoma-specific ds-GPA model enhanced its prognostic accuracy. Addition of CITV to the ds-GPA model significantly improved its prognostic value, with NRI > 0 of 0.366 (95% CI: 0.125-0.607, P = .002) and IDI of 0.024 (95% CI: 0.008-0.040, P = .004). We validated these findings that CITV improves the prognostic utility of melanoma ds-GPA in an independent cohort of 201 melanoma cohort. CONCLUSION: The prognostic value of the ds-GPA scale for melanoma BM is enhanced by the incorporation of CITV.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalClinical Neurosurgery
Volume83
Issue number2
DOIs
StatePublished - Aug 2018

Bibliographical note

Funding Information:
The project described was partially supported by the National Institutes of Health, grant 1TL1TR001443. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Keywords

  • Brain metastases
  • Cumulative intracranial tumor volume
  • Ds-GPA
  • Melanoma
  • Net reclassification index
  • Prognostication
  • Stereotactic radiosurgery

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