Performance status

Metastasis

A549 cell

non-small cell lung cancer (NSCLC)

Cohort

Proportional hazards model

Lung cancer

Radiation therapy

Brain metastasis

Radiosurgery

Internal medicine

Oncology

Medicine

Cancer

Journal of Clinical Oncology

8116 Background: NSCLC is the most common cause of BM and GPA is used as a prognostic index (PI) for BM. We evaluated its validity in a contemporary large cohort treated at a single tertiary care institution. Preliminary data was presented at ASCO 2013. Methods: IRB approved. NSCLC BM treated between 2000 and 2012 was identified from the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database. OS from the diagnosis of NSCLC BM was the primary end point.Cox proportional hazards models were used for data analysis. Results: 958 (54% male) patients were included for final analysis. Median age at BM diagnosis was 62 years (29-92). Karnofsky performance scale (KPS) was 90-100 in 345 (39%), 70-80 in 415 (47%) and <70 in 116 (13%) patients. Single BM was noted in 448 (47%), 2 BM in 169 (18%), 3 BM in 92 (10%), 4 BM in 49 (5%), 5 BM in 56 (6%) and >5 in 136 (14%) patients. Initial therapy included stereotactic radiosurgery (SRS) in 186 (20%) patients, whole brain radiation (WBRT) in 420 (44%), surgery (S) + WBRT in 132 (14%), WBRT + SRS in 138 (15%) and S + SRS in 23 (2%) patients, while 20 patients underwent only S, 11 patients received medical therapy alone, 17 were observed, 1 patient had S, WBRT + SRS. Median OS from diagnosis of BM was 7.8 months (95% C.I. 7.1-8.9).GPA for lung cancer is derived from KPS, number of BM, the presence/absence of extracranial metastases and age. GPA was prognostic for survival with very good separation between each of the groups (p<.0001). Conclusions: Even in the modern era GPA is still a valid PI for OS in NSCLC patients with BM. Factor N (%) Median survival (months) P* KPS 90-100 345 (39%) 12.0 <0.001 70-80 415 (47%) 7.5 < 70 116 (13%) 2.8 Number of brain metastases 1 448 (46%) 10.0 <0.001 2-3 261 (27%) 7.4 >3 241 (25%) 6.3 Extracranial metastases No 434 (46%) 12.1 <0.001 Yes 502 (54%) 5.6 Age (years) <50 122 (13%) 11.9 <0.001 50-60 291 (30%) 9.8 >60 544 (57%) 6.4 GPA 0 - 1.0 209 (24%) 3.4 <0.001 1.5 - 2.0 312 (36%) 7.0 2.5 - 3.0 275 (32%) 13.0 3.5 - 4.0 62 (7%) 23.2 *Proportional hazards model stratified by when brain metastases were diagnosed.

Validation study of graded prognostic assessment (GPA) of non-small cell lung cancer (NSCLC) patients with brain metastasis (BM).