Validation of the graded prognostic assessment and recursive partitioning analysis as prognostic tools using a modern cohort of patients with brain metastases.
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2024-12
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Abstract
Background
Prognostic indices for patients with brain metastases (BM) are needed to individualize treatment and stratify clinical trials. Two frequently used tools to estimate survival in patients with BM are the recursive partitioning analysis (RPA) and the diagnosis-specific graded prognostic assessment (DS-GPA). Given recent advances in therapies and improved survival for patients with BM, this study aims to validate and analyze these 2 models in a modern cohort.Methods
Patients diagnosed with BM were identified via our institution's Tumor Board meetings. Data were retrospectively collected from the date of diagnosis with BM. The concordance of the RPA and GPA was calculated using Harrell's C index. A Cox proportional hazards model with backwards elimination was used to generate a parsimonious model predictive of survival.Results
Our study consisted of 206 patients diagnosed with BM between 2010 and 2019. The RPA had a prediction performance characterized by Harrell's C index of 0.588. The DS-GPA demonstrated a Harrell's C index of 0.630. A Cox proportional hazards model assessing the effect of age, presence of lung, or liver metastases, and Eastern Cooperative Oncology Group (ECOG) performance status score of 3/4 on survival yielded a Harrell's C index of 0.616. Revising the analysis with an uncategorized ECOG demonstrated a C index of 0.648.Conclusions
We found that the performance of the RPA remains unchanged from previous validation studies a decade earlier. The DS-GPA outperformed the RPA in predicting overall survival in our modern cohort. Analyzing variables shared by the RPA and DS-GPA produced a model that performed analogously to the DS-GPA.Type
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Sperber, Jacob, Seeley Yoo, Edwin Owolo, Tara Dalton, Tanner J Zachem, Eli Johnson, James E Herndon, Annee D Nguyen, et al. (2024). Validation of the graded prognostic assessment and recursive partitioning analysis as prognostic tools using a modern cohort of patients with brain metastases. Neuro-oncology practice, 11(6). pp. 763–771. 10.1093/nop/npae057 Retrieved from https://hdl.handle.net/10161/34368.
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Scholars@Duke
Tanner Zachem
James Emmett Herndon
Current research interests have application to the design and analysis of cancer clinical trials. Specifically, interests include the use of time-dependent covariables within survival models, the design of phase II cancer clinical trials which minimize some of the logistical problems associated with their conduct, and the analysis of longitudinal studies with informative censoring (in particular, quality of life studies of patients with advanced cancer).
Annee Nguyen
Annee is a graduate student in Duke's Department of Pharmacology, a joint program with Molecular Cancer Biology. She is excited to identify therapeutic molecules and elucidate therapeutic mechanisms of antitumor efficacy that may also target secondary comorbid conditions, such as pain or neurological deficits. She is passionate about scientific education and communication and hopes to remain in academia with the goal of cultivating the next generation of scientists.
In 2017, Annee graduated from the University of California, San Diego, from Warren College, with a Bachelor of Science in Human Biology (double minoring in Psychology and Theatre) as magna cum laude and as part of the Sigma Chapter of the Phi Beta Kappa Society and obtained a contiguous Master of Science in Biology in 2018, concentrating in Neuropathology and Scientific Communication.
Since 2014, her prior research experience includes working with various preclinical models of peripheral neuropathy (with Dr. Nigel Calcutt and Dr. Christina Sigurdson of UC San Diego’s Department of Pathology), equine and murine models of neuroaxonal dystrophy (with Dr. Carrie Finno of UC Davis’s School of Veterinary Medicine), and CNS tumor preclinical models of recurrent glioblastoma and spine tumors and metastases at Duke University Medical Center with Dr. Rory Goodwin of the Duke Center for Brain and Spine Metastasis and the Department of Neurosurgery. In each lab, she sought to identify therapeutics that could prevent, reverse, or abate the neurodegenerative diseases of focus and explored mechanisms of disease development and therapeutic impact. Throughout her experiences, Annee has continually focused on developing projects driven by clinical impact and focused on taking science from bench to bedside and back.
Paul Wayne Sperduto
I am a board-certified radiation oncologist, have been active in clinical research and am now an adjunct professor of radiation oncology at Duke and senior editor of the 2022 textbook, Khan’s Treatment Planning in Radiation Oncology, 5thedition. My research focus involves the treatment and prognosis of patients with brain metastases.
Margaret Johnson
I am a neuro-oncologist, neurologist, and palliative care physician at the Preston Robert Tisch Brain Tumor Center. I also provide neuro-oncology expertise for the National Tele-Oncology Program and National Precision Oncology Program at the Veteran's Health Administration. My clinical and research interests encompass supportive care and palliative care with a special interest in older adults with brain tumors. The incidence of malignant brain tumors like glioblastoma and non-malignant tumors like meningioma affect aging populations and it is crucial to be able to provide better care for these patients.
Melissa Maria Erickson
I am a spine surgeon who provides surgical management of cervical, thoracic and lumbar spine conditions, including cervical myelopathy, herniated discs, deformity, stenosis, tumor and trauma. I provide both minimally invasive procedures as well as traditional surgical techniques.
Courtney Rory Goodwin
Associate Professor of Neurosurgery, Radiation Oncology, Orthopedic Surgery.
Director of Spine Oncology,
Associate Residency Program Director
Third Year Study Program Director Neurosciences, Duke University School of Medicine
Director of Spine Metastasis, Duke Center for Brain and Spine Metastasis, Department of Neurosurgery
Duke Cancer Institute, Duke University Medical Center
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