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

doi:10.1093/neuros/nyx380

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

Neurosurgery

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18 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 language	English (US)
Pages (from-to)	237-244
Number of pages	8
Journal	Clinical Neurosurgery
Volume	83
Issue number	2
DOIs	https://doi.org/10.1093/neuros/nyx380
State	Published - 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.

Publisher Copyright:
© Crown copyright 2017.

Keywords

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

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10.1093/neuros/nyx380

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Hirshman, B. R., Wilson, B. R., Ali, M. A., Schupper, A. J., Proudfoot, J. A., Goetsch, S. J., Carter, B. S., Sinclair, G., Bartek, J., Chiang, V., Fogarty, G., Hong, A., & Chen, C. C. (2018). Cumulative intracranial tumor volume augments the prognostic value of the diagnosis-specific graded prognostic assessment model for survival in patients with melanoma cerebral metastases. Clinical Neurosurgery, 83(2), 237-244. https://doi.org/10.1093/neuros/nyx380

Cumulative intracranial tumor volume augments the prognostic value of the diagnosis-specific graded prognostic assessment model for survival in patients with melanoma cerebral metastases. / Hirshman, Brian R.; Wilson, Bayard R.; Ali, Mir Amaan et al.

In: Clinical Neurosurgery, Vol. 83, No. 2, 08.2018, p. 237-244.

Research output: Contribution to journal › Article › peer-review

Hirshman, BR, Wilson, BR, Ali, MA, Schupper, AJ, Proudfoot, JA, Goetsch, SJ, Carter, BS, Sinclair, G, Bartek, J, Chiang, V, Fogarty, G, Hong, A & Chen, CC 2018, 'Cumulative intracranial tumor volume augments the prognostic value of the diagnosis-specific graded prognostic assessment model for survival in patients with melanoma cerebral metastases', Clinical Neurosurgery, vol. 83, no. 2, pp. 237-244. https://doi.org/10.1093/neuros/nyx380

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

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.",

keywords = "Brain metastases, Cumulative intracranial tumor volume, Ds-GPA, Melanoma, Net reclassification index, Prognostication, Stereotactic radiosurgery",

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

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. Publisher Copyright: {\textcopyright} Crown copyright 2017.",

year = "2018",

month = aug,

doi = "10.1093/neuros/nyx380",

language = "English (US)",

volume = "83",

pages = "237--244",

journal = "Neurosurgery",

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publisher = "Lippincott Williams and Wilkins",

number = "2",

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TY - JOUR

T1 - Cumulative intracranial tumor volume augments the prognostic value of the diagnosis-specific graded prognostic assessment model for survival in patients with melanoma cerebral metastases

AU - Hirshman, Brian R.

AU - Wilson, Bayard R.

AU - Ali, Mir Amaan

AU - Schupper, Alexander J.

AU - Proudfoot, James A.

AU - Goetsch, Steven J.

AU - Carter, Bob S.

AU - Sinclair, Georges

AU - Bartek, Jiri

AU - Chiang, Veronica

AU - Fogarty, Gerald

AU - Hong, Angela

AU - Chen, Clark C

N1 - 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. Publisher Copyright: © Crown copyright 2017.

PY - 2018/8

Y1 - 2018/8

N2 - 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.

AB - 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.

KW - Brain metastases

KW - Cumulative intracranial tumor volume

KW - Ds-GPA

KW - Melanoma

KW - Net reclassification index

KW - Prognostication

KW - Stereotactic radiosurgery

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U2 - 10.1093/neuros/nyx380

DO - 10.1093/neuros/nyx380

M3 - Article

C2 - 28973506

AN - SCOPUS:85055914948

SN - 0148-396X

VL - 83

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JO - Neurosurgery

JF - Neurosurgery

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ER -

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

Abstract

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