Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA)
Background: Patients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985–2007, n = 209). The purpose of this st...
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doaj-d0fb027d1dc24bdeaaaf52f5f48571502021-06-02T03:15:11ZengElsevierClinical and Translational Radiation Oncology2405-63082019-09-01183945Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA)Paul W. Sperduto0Penny Fang1Jing Li2William Breen3Paul D. Brown4Daniel Cagney5Ayal Aizer6James B. Yu7Veronica Chiang8Supriya Jain9Laurie E. Gaspar10Sten Myrehaug11Arjun Sahgal12Steve Braunstein13Penny Sneed14Brent Cameron15Albert Attia16Jason Molitoris17Cheng-Chia Wu18Tony J.C. Wang19Natalie A. Lockney20Kathryn Beal21Jessica Parkhurst22John M. Buatti23Ryan Shanley24Emil Lou25Daniel D. Tandberg26John P. Kirkpatrick27Diana Shi28Helen A. Shih29Michael Chuong30Hirotake Saito31Hidefumi Aoyama32Laura Masucci33David Roberge34Minesh P. Mehta35Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, USA; Corresponding author at: 560 S. Maple Street, Suite 10, Waconia, MN 55387, USA.MD Anderson Cancer Center, USAMD Anderson Cancer Center, USAMayo Clinic, USAMayo Clinic, USADana Farber Cancer Institute, USADana Farber Cancer Institute, USAYale, USAYale, USAUniversity of Colorado, USAUniversity of Colorado, USASunnybrook, USASunnybrook, USAUniversity of California San Francisco, USAUniversity of California San Francisco, USAVanderbilt University Medical Center, USAVanderbilt University Medical Center, USAUniversity of Maryland, USAColumbia University Medical Center, USAColumbia University Medical Center, USAMemorial Sloan Kettering Cancer Center, USAMemorial Sloan Kettering Cancer Center, USAUniversity of Iowa, USAUniversity of Iowa, USAUniversity of Minnesota, USAUniversity of Minnesota, USADuke University, USADuke University, USAMassachusetts General Hospital, USAMassachusetts General Hospital, USAMiami Cancer Institute, USANiigata University, JapanNiigata University, JapanCentre Hospitalier de l' Université de Montreal, CanadaCentre Hospitalier de l' Université de Montreal, CanadaMiami Cancer Institute, USABackground: Patients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985–2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database. Methods: An IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA. Results: Median survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0–1, 1.5–2, 2.5–3.0 and 3.5–4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0). Conclusions: Brain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com. Keywords: Gastrointestinal cancers, Brain metastases, Prognosis, End-of-lifehttp://www.sciencedirect.com/science/article/pii/S2405630819300539 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul W. Sperduto Penny Fang Jing Li William Breen Paul D. Brown Daniel Cagney Ayal Aizer James B. 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. Wang Natalie A. Lockney Kathryn Beal Jessica Parkhurst John M. Buatti Ryan 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 |
spellingShingle |
Paul W. Sperduto Penny Fang Jing Li William Breen Paul D. Brown Daniel Cagney Ayal Aizer James B. 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. Wang Natalie A. Lockney Kathryn Beal Jessica Parkhurst John M. Buatti Ryan 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 Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) Clinical and Translational Radiation Oncology |
author_facet |
Paul W. Sperduto Penny Fang Jing Li William Breen Paul D. Brown Daniel Cagney Ayal Aizer James B. 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. Wang Natalie A. Lockney Kathryn Beal Jessica Parkhurst John M. Buatti Ryan 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 |
author_sort |
Paul W. Sperduto |
title |
Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) |
title_short |
Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) |
title_full |
Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) |
title_fullStr |
Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) |
title_full_unstemmed |
Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA) |
title_sort |
estimating survival in patients with gastrointestinal cancers and brain metastases: an update of the graded prognostic assessment for gastrointestinal cancers (gi-gpa) |
publisher |
Elsevier |
series |
Clinical and Translational Radiation Oncology |
issn |
2405-6308 |
publishDate |
2019-09-01 |
description |
Background: Patients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985–2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database. Methods: An IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA. Results: Median survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0–1, 1.5–2, 2.5–3.0 and 3.5–4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0). Conclusions: Brain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com. Keywords: Gastrointestinal cancers, Brain metastases, Prognosis, End-of-life |
url |
http://www.sciencedirect.com/science/article/pii/S2405630819300539 |
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