Paul W Sperduto, Kathryn E Marqueen, Enoch Chang, Jing Li, Michael A Davies, Daniel K Ebner, William G Breen, Nayan Lamba, Helen A Shih, Donna Edwards, Michelle M Kim, Amandeep Mahal, Rifaquat Rahman, Nii Ankrah, Drexell H Boggs, Calvin Lewis, Daniel Hyer, John M Buatti, Fasila Johri, Hany Soliman, Laura Masucci, David Roberge, Sanjay Aneja, Veronica Chiang, Christina Phuong, Steve Braunstein, Salah Dajani, Sean Sachdev, Zihan Wan, Donna Niedzwiecki, Eugene Vaios, John P Kirkpatrick, Jared Pasetsky, Tony J C Wang, Tugce Kutuk, Rupesh Kotecha, Richard B Ross, Chad G Rusthoven, Toshimichi Nakano, Hussein A Tawbi, Minesh P Mehta
{"title":"改善黑色素瘤脑转移患者的生存和预后：黑色素瘤分级预后评估的最新进展。","authors":"Paul W Sperduto, Kathryn E Marqueen, Enoch Chang, Jing Li, Michael A Davies, Daniel K Ebner, William G Breen, Nayan Lamba, Helen A Shih, Donna Edwards, Michelle M Kim, Amandeep Mahal, Rifaquat Rahman, Nii Ankrah, Drexell H Boggs, Calvin Lewis, Daniel Hyer, John M Buatti, Fasila Johri, Hany Soliman, Laura Masucci, David Roberge, Sanjay Aneja, Veronica Chiang, Christina Phuong, Steve Braunstein, Salah Dajani, Sean Sachdev, Zihan Wan, Donna Niedzwiecki, Eugene Vaios, John P Kirkpatrick, Jared Pasetsky, Tony J C Wang, Tugce Kutuk, Rupesh Kotecha, Richard B Ross, Chad G Rusthoven, Toshimichi Nakano, Hussein A Tawbi, Minesh P Mehta","doi":"10.1200/JCO-24-01351","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Survival for patients with melanoma has recently improved. The propensity of melanoma to metastasize to the brain remains a common and serious feature of this disease. The purposes of this study were to evaluate prognostic factors for patients with newly diagnosed melanoma brain metastases (MBMs) in a large cohort treated with modern multimodal therapies, compare those results with those in prior eras, and update the Melanoma Graded Prognostic Assessment (GPA).</p><p><strong>Methods: </strong>Univariable and multivariable (MVA) analyses of prognostic factors and treatments associated with survival were performed on 1,796 patients with newly diagnosed MBM treated between January 01, 2015, and December 31, 2021, using a multi-institutional retrospective database. Multiple imputation was used to address missingness of potential predictors. Significant variables in combined MVA were used to update the Melanoma GPA. Comparisons were made with legacy cohorts.</p><p><strong>Results: </strong>Median survivals for cohorts A (1985-2007, n = 481), B (2006-2015, n = 823), and C (2015-2021, n = 1,796) were 6.7, 9.8, and 16.6 months and median follow-up times were 40.1, 43.6, and 48.8 months, respectively. In combined MVA, significant prognostic factors for survival were higher Karnofsky Performance Status, fewer MBMs, absence of extracranial metastases, lower serum lactate dehydrogenase, and no immunotherapy before MBM. These factors were incorporated into the updated Melanoma GPA. The combined median and 3-year survivals for patients with GPA 0-1, 1.5-2, and 2.5-4.0 were 5.4, 13.2, and 43.2 months and 12.4%, 28.8%, and 51.6%, respectively.</p><p><strong>Conclusion: </strong>Prognostic factors have changed and survival has improved for patients with MBM but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"JCO2401351"},"PeriodicalIF":42.1000,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improved Survival and Prognostication in Melanoma Patients With Brain Metastases: An Update of the Melanoma Graded Prognostic Assessment.\",\"authors\":\"Paul W Sperduto, Kathryn E Marqueen, Enoch Chang, Jing Li, Michael A Davies, Daniel K Ebner, William G Breen, Nayan Lamba, Helen A Shih, Donna Edwards, Michelle M Kim, Amandeep Mahal, Rifaquat Rahman, Nii Ankrah, Drexell H Boggs, Calvin Lewis, Daniel Hyer, John M Buatti, Fasila Johri, Hany Soliman, Laura Masucci, David Roberge, Sanjay Aneja, Veronica Chiang, Christina Phuong, Steve Braunstein, Salah Dajani, Sean Sachdev, Zihan Wan, Donna Niedzwiecki, Eugene Vaios, John P Kirkpatrick, Jared Pasetsky, Tony J C Wang, Tugce Kutuk, Rupesh Kotecha, Richard B Ross, Chad G Rusthoven, Toshimichi Nakano, Hussein A Tawbi, Minesh P Mehta\",\"doi\":\"10.1200/JCO-24-01351\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Survival for patients with melanoma has recently improved. The propensity of melanoma to metastasize to the brain remains a common and serious feature of this disease. The purposes of this study were to evaluate prognostic factors for patients with newly diagnosed melanoma brain metastases (MBMs) in a large cohort treated with modern multimodal therapies, compare those results with those in prior eras, and update the Melanoma Graded Prognostic Assessment (GPA).</p><p><strong>Methods: </strong>Univariable and multivariable (MVA) analyses of prognostic factors and treatments associated with survival were performed on 1,796 patients with newly diagnosed MBM treated between January 01, 2015, and December 31, 2021, using a multi-institutional retrospective database. Multiple imputation was used to address missingness of potential predictors. Significant variables in combined MVA were used to update the Melanoma GPA. Comparisons were made with legacy cohorts.</p><p><strong>Results: </strong>Median survivals for cohorts A (1985-2007, n = 481), B (2006-2015, n = 823), and C (2015-2021, n = 1,796) were 6.7, 9.8, and 16.6 months and median follow-up times were 40.1, 43.6, and 48.8 months, respectively. In combined MVA, significant prognostic factors for survival were higher Karnofsky Performance Status, fewer MBMs, absence of extracranial metastases, lower serum lactate dehydrogenase, and no immunotherapy before MBM. These factors were incorporated into the updated Melanoma GPA. The combined median and 3-year survivals for patients with GPA 0-1, 1.5-2, and 2.5-4.0 were 5.4, 13.2, and 43.2 months and 12.4%, 28.8%, and 51.6%, respectively.</p><p><strong>Conclusion: </strong>Prognostic factors have changed and survival has improved for patients with MBM but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.</p>\",\"PeriodicalId\":15384,\"journal\":{\"name\":\"Journal of Clinical Oncology\",\"volume\":\" \",\"pages\":\"JCO2401351\"},\"PeriodicalIF\":42.1000,\"publicationDate\":\"2025-04-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1200/JCO-24-01351\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1200/JCO-24-01351","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Improved Survival and Prognostication in Melanoma Patients With Brain Metastases: An Update of the Melanoma Graded Prognostic Assessment.
Purpose: Survival for patients with melanoma has recently improved. The propensity of melanoma to metastasize to the brain remains a common and serious feature of this disease. The purposes of this study were to evaluate prognostic factors for patients with newly diagnosed melanoma brain metastases (MBMs) in a large cohort treated with modern multimodal therapies, compare those results with those in prior eras, and update the Melanoma Graded Prognostic Assessment (GPA).
Methods: Univariable and multivariable (MVA) analyses of prognostic factors and treatments associated with survival were performed on 1,796 patients with newly diagnosed MBM treated between January 01, 2015, and December 31, 2021, using a multi-institutional retrospective database. Multiple imputation was used to address missingness of potential predictors. Significant variables in combined MVA were used to update the Melanoma GPA. Comparisons were made with legacy cohorts.
Results: Median survivals for cohorts A (1985-2007, n = 481), B (2006-2015, n = 823), and C (2015-2021, n = 1,796) were 6.7, 9.8, and 16.6 months and median follow-up times were 40.1, 43.6, and 48.8 months, respectively. In combined MVA, significant prognostic factors for survival were higher Karnofsky Performance Status, fewer MBMs, absence of extracranial metastases, lower serum lactate dehydrogenase, and no immunotherapy before MBM. These factors were incorporated into the updated Melanoma GPA. The combined median and 3-year survivals for patients with GPA 0-1, 1.5-2, and 2.5-4.0 were 5.4, 13.2, and 43.2 months and 12.4%, 28.8%, and 51.6%, respectively.
Conclusion: Prognostic factors have changed and survival has improved for patients with MBM but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.
期刊介绍：
The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.
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