339 Comparative Prognostic Value of the Cumulative Intracranial Tumor Volume and Score Index for Radiosurgery in Brain Metastasis. (1st August 2016)

• Record Type: Journal Article
• Authors: Hirshman, Brian R.; Wilson, Bayard; James, Proudfoot A.; Koiso, Takao; Nagano, Osamu; Carter, Bob S.; Serizawa, Toru; Yamamoto, Masaaki; Chen, Clark C.
• Is Part Of: Neurosurgery. Volume 63:(2016)Supplement 1
• Page Start: 199
• Page End: 199
• Publication Date: 2016-08-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/01.neu.0000489828.00133.eb
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: There are 2 published prognostic scales for brain metastasis (BM) patients undergoing radiosurgery that take into consideration the volume of the tumor treated. The score index for radiosurgery (SIR) inputs the largest tumor volume treated as a survival predictor, while the cumulative intracranial tumor volume (CITV) inputs the total cumulative volume of the tumors treated. It remains unclear whether 1 scale is superior in terms of predicting survival. METHODS: We compared the sensitivity and specificity of SIR and CITV scales in predicting 1-year survival using standard measures of continuous data: Net Reclassification Index (NRI > 0) and Integrated Discrimination Improvement (IDI). The analysis was performed in 2 independent cohorts: 3020 BM patients treated at either the University of California San Diego (UCSD) or the Katsuta Hospital Mito Gamma House (KHMGH), and a second cohort of 3040 patients treated at Chiba/Tsukiji (CT) hospital. RESULTS: In both cohorts, models incorporating age, Karnofsky performance score, presence of extracranial disease, number of metastases, and CITV performed better than models where CITV was replaced with the largest tumor volume. In the first cohort, models incorporating CITV showed a Net Reclassification Index ([NRI] >0) improvement 0.2416 (95% confidence interval [CI], 0.1637-0.3194) and Integrated Discrimination Improvement (IDI) of 0.0029 (95% CI, 0.0001-0.0064) relative to models incorporating the largest lesion size. Similar results were observed in the second cohort (NRI > 0 of 0.2431 [95% CI, 0.1692-0.3171] and IDI of 0.0068 [95% CI, 0.0003-0.0011]). CONCLUSION: In both cohorts, models incorporating age, Karnofsky performance score, presence of extracranial disease, number of metastases, and CITV performed better than models where CITV was replaced with the largest tumor volume. In the first cohort, models incorporating CITV showed a Net Reclassification Index (NRI > 0) improvement 0.2416 (95% CI, 0.1637-0.3194) and, IDI of 0.0029 (95% CI, 0.0001-0.0064) relative to models incorporating the largest lesion size. Similar results were observed in the second cohort (NRI >0 of 0.2431 [95% CI, 0.1692-0.3171] and IDI of 0.0068 [95% CI, 0.0003-0.0011]).