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Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement.

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Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Nieder, C. Marienhagen, K. Dalhaug, A. Aandahl, G. Haukland, E. Pawinski, A.
Description	Author Affiliation: Nieder C ( Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway); Marienhagen K ( Department of Oncology, University Hospital of North Norway, Tromsø, Norway.); Dalhaug A ( Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway); Aandahl G ( Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.); Haukland E ( Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.); Pawinski A ( Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.)
Abstract	AIMS: To explore the role of expanded assessment of metastatic extracranial organ involvement, as well as albumin and lactate dehydrogenase (LDH), i.e. surrogates of disease extent, in survival prediction models for patients with brain metastases. MATERIALS AND METHODS: A retrospective analysis of 189 patients treated with whole brain radiotherapy was carried out. Uni- and multivariate analyses included recursive partitioning analysis classes, basic score for brain metastases and diagnosis-specific graded prognostic assessment (DS-GPA). RESULTS: Elevated LDH correlated significantly with extracranial organ involvement, low albumin with primary tumour type and primary tumour control. Elevated LDH, low albumin and a combination of both correlated significantly with overall survival. LDH, albumin and the number of extracranial organs involved (none, one, two or more harbouring metastases) were independent prognostic factors in multivariate analyses (if added to the three established scores mentioned above and also if added to individual parameters such as age, performance status, etc.). A combination of these three new prognostic factors predicted very short survival (median 0.7 months if all three were present). CONCLUSION: We have previously defined patient groups in whom foregoing radiotherapy was unlikely to compromise survival. These were patients with a DS-GPA score of 0-1.5 points and age ≥75 years or Karnofsky performance status ≤50 or uncontrolled primary tumour with extracranial metastases to at least two organs. Patients with a combination of three new adverse features (elevated LDH plus low albumin plus extracranial metastases to at least two organs) might also be considered for best supportive care. Furthermore, it appears warranted to study whether scores such as DS-GPA can be optimised by integrating information on these three parameters.
File Format	HTM / HTML
ISSN	09366555
Issue Number	8
Volume Number	26
e-ISSN	14332981
Journal	Clinical Oncology
Language	English
Publisher	Elsevier
Publisher Date	2014-08-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Oncology Brain Neoplasms Mortality Secondary L-lactate Dehydrogenase Metabolism Adult Aged Aged, 80 And Over Analysis Of Variance Radiotherapy Female Humans Kaplan-meier Estimate Male Middle Aged Models, Statistical Neoplasm Metastasis Prognosis Regression Analysis Retrospective Studies Serum Albumin Young Adult Journal Article
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Oncology

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