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Article: Individualized Nomogram for Predicting Survival in Patients with Brain Metastases After Stereotactic Radiosurgery Utilizing Driver Gene Mutations and Volumetric Surrogates

TitleIndividualized Nomogram for Predicting Survival in Patients with Brain Metastases After Stereotactic Radiosurgery Utilizing Driver Gene Mutations and Volumetric Surrogates
Authors
Keywordsbrain metastases
stereotactic radiosurgery
nomogram
gene mutation
prediction model
Issue Date2021
PublisherFrontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology
Citation
Frontiers in Oncology, 2021, v. 11, p. article no. 659538 How to Cite?
AbstractIt is well-known that genomic mutational analysis plays a significant role in patients with NSCLC for personalized treatment. Given the increasing use of stereotactic radiosurgery (SRS) for brain metastases (BM), there is an emerging need for more precise assessment of survival outcomes after SRS. Patients with BM and treated by SRS were eligible in this study. The primary endpoint was overall survival (OS). Cox regression models were used to identify independent prognostic factors. A survival predictive nomogram was developed and evaluated by Concordance-index (C-index), area under the curve (AUC), and calibration curve. From January 2016 to December 2019, a total of 356 BM patients were eligible. The median OS was 17.7 months [95% confidence interval (CI) 15.5–19.9] and the actual OS at 1- and 2-years measured 63.2 and 37.6%, respectively. A nomogram for OS was developed by incorporating four independent prognostic factors: Karnofsky Performance Score, cumulative tumor volume, gene mutation status, and serum lactate dehydrogenase. The nomogram was validated in a separate cohort and demonstrated good calibration and good discriminative ability (C-index = 0.780, AUC = 0.784). The prognostic accuracy of the nomogram (0.792) was considerably enhanced when compared with classical prognostic indices, including the Graded Prognostic Assessment (0.708), recursive partitioning analysis (0.587), and the SRS (0.536). Kaplan–Meier curves showed significant differences in OS among the stratified low-, median- and high-risk groups (P < 0.001). In conclusion, we developed and validated an individualized prognostic nomogram by integrating physiological, volumetric, clinical chemistry, and molecular biological surrogates. Although this nomogram should be validated by independent external study, it has a potential to facilitate more precise risk-stratifications to guide personalized treatment for BM.
Persistent Identifierhttp://hdl.handle.net/10722/302051
ISSN
2023 Impact Factor: 3.5
2023 SCImago Journal Rankings: 1.066
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorZhou, C-
dc.contributor.authorShan, C-
dc.contributor.authorLai, M-
dc.contributor.authorZhen, Z-
dc.contributor.authorZhen, J-
dc.contributor.authorDeng, G-
dc.contributor.authorLi, H-
dc.contributor.authorLi, J-
dc.contributor.authorRen, C-
dc.contributor.authorWang, J-
dc.contributor.authorLu, M-
dc.contributor.authorZhang, L-
dc.contributor.authorWu, T-
dc.contributor.authorZhu, D-
dc.contributor.authorKong, FMP-
dc.contributor.authorChen, L-
dc.contributor.authorCai, L-
dc.contributor.authorWen, L-
dc.date.accessioned2021-08-21T03:30:52Z-
dc.date.available2021-08-21T03:30:52Z-
dc.date.issued2021-
dc.identifier.citationFrontiers in Oncology, 2021, v. 11, p. article no. 659538-
dc.identifier.issn2234-943X-
dc.identifier.urihttp://hdl.handle.net/10722/302051-
dc.description.abstractIt is well-known that genomic mutational analysis plays a significant role in patients with NSCLC for personalized treatment. Given the increasing use of stereotactic radiosurgery (SRS) for brain metastases (BM), there is an emerging need for more precise assessment of survival outcomes after SRS. Patients with BM and treated by SRS were eligible in this study. The primary endpoint was overall survival (OS). Cox regression models were used to identify independent prognostic factors. A survival predictive nomogram was developed and evaluated by Concordance-index (C-index), area under the curve (AUC), and calibration curve. From January 2016 to December 2019, a total of 356 BM patients were eligible. The median OS was 17.7 months [95% confidence interval (CI) 15.5–19.9] and the actual OS at 1- and 2-years measured 63.2 and 37.6%, respectively. A nomogram for OS was developed by incorporating four independent prognostic factors: Karnofsky Performance Score, cumulative tumor volume, gene mutation status, and serum lactate dehydrogenase. The nomogram was validated in a separate cohort and demonstrated good calibration and good discriminative ability (C-index = 0.780, AUC = 0.784). The prognostic accuracy of the nomogram (0.792) was considerably enhanced when compared with classical prognostic indices, including the Graded Prognostic Assessment (0.708), recursive partitioning analysis (0.587), and the SRS (0.536). Kaplan–Meier curves showed significant differences in OS among the stratified low-, median- and high-risk groups (P < 0.001). In conclusion, we developed and validated an individualized prognostic nomogram by integrating physiological, volumetric, clinical chemistry, and molecular biological surrogates. Although this nomogram should be validated by independent external study, it has a potential to facilitate more precise risk-stratifications to guide personalized treatment for BM.-
dc.languageeng-
dc.publisherFrontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology-
dc.relation.ispartofFrontiers in Oncology-
dc.rightsThis Document is Protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectbrain metastases-
dc.subjectstereotactic radiosurgery-
dc.subjectnomogram-
dc.subjectgene mutation-
dc.subjectprediction model-
dc.titleIndividualized Nomogram for Predicting Survival in Patients with Brain Metastases After Stereotactic Radiosurgery Utilizing Driver Gene Mutations and Volumetric Surrogates-
dc.typeArticle-
dc.identifier.emailKong, FMP: kong0001@hku.hk-
dc.identifier.authorityKong, FMP=rp02508-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3389/fonc.2021.659538-
dc.identifier.pmid34055626-
dc.identifier.pmcidPMC8158152-
dc.identifier.scopuseid_2-s2.0-85107056770-
dc.identifier.hkuros324252-
dc.identifier.volume11-
dc.identifier.spagearticle no. 659538-
dc.identifier.epagearticle no. 659538-
dc.identifier.isiWOS:000655121700001-
dc.publisher.placeSwitzerland-

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