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Prognostic Importance of Cumulative Intracranial Tumor Volume (CITV) in Gastrointestinal (GI) Brain Metastasis Patients Treated with Stereotactic Radiosurgery.

World Neurosurgery 2018 October 9
BACKGROUND: The disease-specific Graded Prognostic Assessment (ds-GPA) for patients with gastrointestinal (GI) tract cancer brain metastases (BM) suggests Karnofsky Performance Score (KPS) as the only pertinent prognostic factor. We evaluated the prognostic importance of cumulative intracranial tumor volume (CITV).

METHODS: KPS, CITV, and overall survival (OS) were collected from consecutive SRS-treated GI BM patients. Patients were grouped into two independent cohorts for development and validation of the model (termed "exploratory" and "validation" cohorts). Analyses were performed using logistic regression, Cox proportional hazards models, net reclassification index (NRI>0), integrated discrimination improvement (IDI>0), and Akaike information criterion (AIC).

RESULTS: In univariable logistic regression models, both CITV and KPS independently associated with patient survival. The association between CITV and overall survival remained robust after controlling for KPS (p<0.001) in a multivariable Cox proportional hazards model. Based on NRI analysis of the exploratory cohort, we found that a CITV cutoff of 12 cubic centimeters (cc's) best augments the prognostic accuracy of GI-ds-GPA. In this analysis, incorporation of CITV (as < or > 12cc's) improved prognostication of the GI-specific GPA model by NRI>0 of 0.397 (95% CI: 0.165-0.630, p<0.001) and IDI of 0.019 (95% CI: 0.004-0.033, p=0.013). We confirmed the prognostic utility of the CITV-incorporated GI-ds-GPA in an independent validation cohort, where CITV incorporation improved prognostic utility with an NRI>0 of 0.478 (95% CI: 0.257-0.699, p<0.001) and IDI of 0.028 (95% CI: 0.014-0.043, p<0.001).

CONCLUSION: CITV is an important prognostic variable in SRS-treated GI BM patients and augments the prognostic accuracy of the GI-ds-GPA index.

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