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Neurosurgery. 2018 Apr 1;82(4):473-480. doi: 10.1093/neuros/nyx225.

Superior Prognostic Value of Cumulative Intracranial Tumor Volume Relative to Largest Intracranial Tumor Volume for Stereotactic Radiosurgery-Treated Brain Metastasis Patients.

Author information

1
Department of Neurosurgery, Center for Translational and Applied Neuro-Oncology, University of California, San Diego, La Jolla, California.
2
Clinical and Translational Research Institute, University of California San Diego, San Diego, California.
3
Department of Neurosurgery, Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan.
4
Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan.
5
Tsukiji Neurological Clinic, Tokyo Gamma Unit Center, Tokyo, Japan.

Abstract

BACKGROUND:

Two intracranial tumor volume variables have been shown to prognosticate survival of stereotactic-radiosurgery-treated brain metastasis patients: the largest intracranial tumor volume (LITV) and the cumulative intracranial tumor volume (CITV).

OBJECTIVE:

To determine whether the prognostic value of the Scored Index for Radiosurgery (SIR) model can be improved by replacing one of its components-LITV-with CITV.

METHODS:

We compared LITV and CITV in terms of their survival prognostication using a series of multivariable models that included known components of the SIR: age, Karnofsky Performance Score, status of extracranial disease, and the number of brain metastases. Models were compared using established statistical measures, including the net reclassification improvement (NRI > 0) and integrated discrimination improvement (IDI). The analysis was performed in 2 independent cohorts, each consisting of ∼3000 patients.

RESULTS:

In both cohorts, CITV was shown to be independently predictive of patient survival. Replacement of LITV with CITV in the SIR model improved the model's ability to predict 1-yr survival. In the first cohort, the CITV model showed an NRI > 0 improvement of 0.2574 (95% confidence interval [CI] 0.1890-0.3257) and IDI of 0.0088 (95% CI 0.0057-0.0119) relative to the LITV model. In the second cohort, the CITV model showed a NRI > 0 of 0.2604 (95% CI 0.1796-0.3411) and IDI of 0.0051 (95% CI 0.0029-0.0073) relative to the LITV model.

CONCLUSION:

After accounting for covariates within the SIR model, CITV offers superior prognostic value relative to LITV for stereotactic radiosurgery-treated brain metastasis patients.

PMID:
28658940
PMCID:
PMC5745302
DOI:
10.1093/neuros/nyx225
[Indexed for MEDLINE]
Free PMC Article

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