Survival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress?

Paul W. Sperduto, Penny Fang, Jing Li, William Breen, Paul D. Brown, Daniel Cagney, Ayal Aizer, James Yu, Veronica Chiang, Supriya Jain, Laurie E. Gaspar, Sten Myrehaug, Arjun Sahgal, Steve Braunstein, Penny Sneed, Brent Cameron, Albert Attia, Jason Molitoris, Cheng Chia Wu, Tony J.C. WangNatalie Lockney, Kathryn Beal, Jessica Parkhurst, John M. Buatti, Ryan M Shanley, Emil Lou, Daniel D. Tandberg, John P. Kirkpatrick, Diana Shi, Helen A. Shih, Michael Chuong, Hirotake Saito, Hidefumi Aoyama, Laura Masucci, David Roberge, Minesh P. Mehta

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

The literature describing the prognosis of patients with gastrointestinal (GI)cancers and brain metastases (BM)is sparse. Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA)for GI cancer patients with BM, based on 209 patients diagnosed from 1985–2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort. A multi-institutional retrospective IRB-approved database of 792 GI cancer patients with new BM diagnosed from 1/1/2006 to 12/31/2016 was created. Demographic data, clinical parameters, and treatment were correlated with survival and time from primary diagnosis to BM (TPDBM). Kaplan–Meier median survival (MS)estimates were calculated and compared with log-rank tests. The MS from time of first treatment for BM for the prior and current cohorts were 5 and 8 months, respectively (P < 0.001). Eight prognostic factors (age, stage, primary site, resection of primary tumor, Karnofsky Performance Status (KPS), extracranial metastases, number of BM and Hgb were found to be significant for survival, in contrast to only one (KPS)in the prior cohort. In this cohort, the most common primary sites were rectum (24%)and esophagus (23%). Median TPDBM was 22 months. Notably, 37% (267/716)presented with poor prognosis (GPA 0–1.0). Although little improvement in overall survival in this cohort has been achieved in recent decades, survival varies widely and multiple new prognostic factors were identified. Future work will translate these factors into a prognostic index to facilitate clinical decision-making and stratification of future clinical trials.

Original languageEnglish (US)
Pages (from-to)63-72
Number of pages10
JournalTranslational Research
Volume208
DOIs
StatePublished - Jun 2019

Bibliographical note

Funding Information:
Database support and management: Susan Lowry, Database Programmer/Analyst and REDCap Administrator, Biostatistical Design and Analysis Center, Clinical and Translational Science Institute (CTSI), University of Minnesota, 717 Delaware St. SE, Room 140-21, Minneapolis, MN 55414. Funding was received from National Institutes of Health (NIH)grant number UL1TR002494 from the National Center for Advancing Translational Sciences (NCATS). Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Minnesota. NIH grant number P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and the NCATS. The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication was solely the responsibility of the authors and does not necessarily represent the official views of the funders/sponsors (National Center for Research Resources or the NIH). Paul Sperduto and Ryan Shanley had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read the journal's authorship agreement and all authors have reviewed and approved the manuscript. Conflict of Interest: PWS, PF, JL, WB, PDB, DC, JBY, VC, SJ, LEG, SM, SB, PS, BC, A Attia, JKM, CCW, JP, JMB, RS, DDT, DS, MC, HS, HA, LM; Reported relationships, none of which are related to this work: A Aizer (Astra Zeneca), AS (Elekta, Varian, Accuray), TJCW (Merck, Astra-Zeneca, Doximity, Novocure, Elekta, Wolters Kluwer), EL (Novocure, Nomocan Pharmaceuticals), JPK (Varian), HAS (Genentech), DR (Varian, Siemens, Accuray, BrainLab, Elekta, Pfizer, EMD Serono), MPM (Agenus, Insys, Remedy, IBA, Varian, Oncoceutics, Astra-Zeneca, Monteris.

Funding Information:
Funding was received from National Institutes of Health (NIH) grant number UL1TR002494 from the National Center for Advancing Translational Sciences (NCATS). Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Minnesota. NIH grant number P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and the NCATS. The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication was solely the responsibility of the authors and does not necessarily represent the official views of the funders/sponsors (National Center for Research Resources or the NIH).

Publisher Copyright:
© 2019 Elsevier Inc.

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