Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool

Paul W Sperduto; Brian J Deegan; Jing Li; Krishan R Jethwa; Paul D Brown; Natalie Lockney; Kathryn Beal; Nitesh G Rana; Albert Attia; Chia-Lin Tseng; Arjun Sahgal; Ryan Shanley; William A Sperduto; Emil Lou; Amir Zahra; John M Buatti; James B Yu; Veronica Chiang; Jason K Molitoris; Laura Masucci; David Roberge; Diana D Shi; Helen A Shih; Adam Olson; John P Kirkpatrick; Steve Braunstein; Penny Sneed; Minesh P Mehta

doi:10.1093/neuonc/noy099

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Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool

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Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool

Paul W Sperduto, Brian J Deegan, Jing Li, Krishan R Jethwa, Paul D Brown, Natalie Lockney, Kathryn Beal, Nitesh G Rana, Albert Attia, Chia-Lin Tseng, …

Neuro-oncology (Charlottesville, Va.), Vol.20(12), pp.1652-1660

11/12/2018

DOI: 10.1093/neuonc/noy099

PMCID: PMC6231200

PMID: 30418657

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Abstract

Abstract Background Brain metastases are a common complication of renal cell carcinoma (RCC). Our group previously published the Renal Graded Prognostic Assessment (GPA) tool. In our prior RCC study (n = 286, 1985–2005), we found marked heterogeneity and variation in outcomes. In our recent update in a larger, more contemporary cohort, we identified additional significant prognostic factors. The purpose of this study is to update the original Renal-GPA based on the newly identified prognostic factors. Methods A multi-institutional retrospective institutional review board–approved database of 711 RCC patients with new brain metastases diagnosed from January 1, 2006 to December 31, 2015 was created. Clinical parameters and treatment were correlated with survival. A revised Renal GPA index was designed by weighting the most significant factors in proportion to their hazard ratios and assigning scores such that the patients with the best and worst prognoses would have a GPA of 4.0 and 0.0, respectively. Results The 4 most significant factors were Karnofsky performance status, number of brain metastases, extracranial metastases, and hemoglobin. The overall median survival was 12 months. Median survival for GPA groups 0–1.0, 1.5–2.0, 2.5–3, and 3.5–4.0 (% n = 25, 27, 30 and 17) was 4, 12, 17, and 35 months, respectively. Conclusion The updated Renal GPA is a user-friendly tool that will help clinicians and patients better understand prognosis, individualize clinical decision making and treatment selection, provide a means to compare retrospective literature, and provide more robust stratification of future clinical trials in this heterogeneous population. To simplify use of this tool in daily practice, a free online application is available at brainmetgpa.com.

prognosis

renal cell carcinoma

brain metastases

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Title: Subtitle: Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool
Creators: Paul W Sperduto - Minneapolis Radiation Oncology & University of Minnesota Gamma Knife Center, Minneapolis, Minnesota
Brian J Deegan - The University of Texas MD Anderson Cancer Center
Jing Li - The University of Texas MD Anderson Cancer Center
Krishan R Jethwa - Mayo Clinic Department of Radiation Oncology Rochester Minnesota
Paul D Brown - Mayo Clinic Department of Radiation Oncology Rochester Minnesota
Natalie Lockney - Memorial Sloan Kettering Cancer Center
Kathryn Beal - Memorial Sloan Kettering Cancer Center
Nitesh G Rana - Vanderbilt University
Albert Attia - Vanderbilt University
Chia-Lin Tseng - Sunnybrook Health Science Centre
Arjun Sahgal - Sunnybrook Health Science Centre
Ryan Shanley - University of Minnesota
William A Sperduto - University of Minnesota Medical Center
Emil Lou - University of Minnesota Medical Center
Amir Zahra - University of Iowa
John M Buatti - University of Iowa
James B Yu - Yale University
Veronica Chiang - Yale University
Jason K Molitoris - University of Maryland, Department of Radiation Oncology, Baltimore, Maryland
Laura Masucci - Centre Hospitalier de l’Université de Montréal
David Roberge - Centre Hospitalier de l’Université de Montréal
Diana D Shi - Massachusetts General Hospital
Helen A Shih - Massachusetts General Hospital
Adam Olson - Duke University
John P Kirkpatrick - Duke University
Steve Braunstein - University of California, San Francisco
Penny Sneed - University of California, San Francisco
Minesh P Mehta - Miami Cancer Institute, Department of Radiation Oncology, Miami, Florida.
Resource Type: Journal article
Publication Details: Neuro-oncology (Charlottesville, Va.), Vol.20(12), pp.1652-1660
DOI: 10.1093/neuonc/noy099
PMID: 30418657
PMCID: PMC6231200
NLM abbreviation: Neuro Oncol
ISSN: 1522-8517
eISSN: 1523-5866
Publisher: Oxford University Press
Grant note: UL1TR000114; P30 CA77598 / National Institutes of Health (10.13039/100000002) Biostatistics and Bioinformatics Core
Language: English
Date published: 11/12/2018
Academic Unit: Radiation Oncology; Neurosurgery; Otolaryngology
Record Identifier: 9984304031802771

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