Improving the Prognostic Value of Disease-Specific Graded Prognostic Assessment Model for Renal Cell Carcinoma by Incorporation of Cumulative Intracranial Tumor Volume

Mir Amaan Ali, Brian R. Hirshman, Bayard Wilson, Alexander J. Schupper, Rushikesh Joshi, James A. Proudfoot, Steven J. Goetsch, John F. Alksne, Kenneth Ott, Hitoshi Aiyama, Osamu Nagano, Bob S. Carter, Veronica Chiang, Toru Serizawa, Masaaki Yamamoto, Clark C. Chen

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of a disease-specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). Methods Patient and tumor characteristics were collected from RCC cohorts with new BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. Results In univariable logistic regression models, CITV, KPS, and the number of BM were independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P = 0.042). The incorporation of the CITV into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI >0 of 0.3156 (95% confidence interval [CI], 0.0883–0.5428; P = 0.0065) and IDI of 0.0151 (95% CI, 0.0036–0.0277; P = 0.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. Conclusion CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV.

Original languageEnglish (US)
Pages (from-to)151-156
Number of pages6
JournalWorld neurosurgery
Volume108
DOIs
StatePublished - Dec 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • Brain metastasis
  • Cerebral metastasis
  • Cumulative intracranial volume
  • GPA
  • Net reclassification index
  • Prognostication
  • RPA
  • Renal cell carcinoma
  • SIR
  • Stereotactic radiosurgery
  • ds-GPA

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