Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA)

External Validation of an Extended Prognostic Assessment Model in Patients With Brain Metastases from Small-cell Lung Cancer

Background/Aim

Recently, the small-cell lung cancer (SCLC) grade model for patients with brain metastases was developed by a Japanese group. It includes sex, performance status, number of brain metastases, primary tumor control and presence of extracranial metastases. The aim of the present study was to validate this prognostic score in a European cohort of patients.

Patients and Methods

The retrospective validation study included 189 patients from two centers in Germany and Norway. Survival according to the SCLC grade score was evaluated. Additional prognostic factors were analyzed.

Results

Median survival was 7.5 months. The 3-tiered SCLC grade score based on the sum of adverse prognostic features was significantly associated with survival (p<0.001): A higher point sum resulted in shorter survival. However, in our validation cohort, age affected survival to the same degree as several parameters that were part of the score.

Conclusion

This validation study supports the international applicability of the SCLC grade model. Age, which has also been identified as a relevant prognostic factor in other previous studies (including the SCLC Graded Prognostic Assessment), may deserve consideration when trying to optimize survival prediction. Given that different studies identified different age limits, e.g., 70 or 75 years, merged databases are needed to provide definitive conclusions.

Development and adaptations of the Graded Prognostic Assessment (GPA) scale: a systematic review

The Graded Prognostic Assessment (GPA) score has the best accuracy among prognostic scales for patients with brain metastases (BM). A wide range of GPA-derived scales have been established to different types of primary tumor BM. However, there is a high variability between them, and their characteristics have not been described altogether yet. We aim to summarize the features of the existent GPA-derived scales and to compare their predictor factors and their uses in clinical setting. Medline was searched from inception until January 2023 to identify studies related to the development, update, or validation of GPA. The initial search yielded 1,083 results. 16 original studies and 16 validation studies were included, comprising a total of 33,348 patients. 13 different scales were assessed, including: GPA, Diagnosis-Specific GPA, Extracranial Score, Lung-molGPA, Updated Renal GPA, Updated Gastrointestinal GPA, Modified Breast GPA, Integrated Melanoma GPA, Melanoma Mol GPA, Sarcoma GPA, Hepatocellular Carcinoma GPA, Colorectal Cancer GPA, and Uterine Cancer GPA. The most prevalent prognostic predictors were age, Karnofsky Performance Status, number of BM, and presence or absence of extracranial metastases. Treatment modalities consisted of whole brain radiation therapy, stereotactic radiosurgery, surgery, cranial radiotherapy, gamma knife radiosurgery, and BRAF inhibitor therapy. Median survival rates with no treatment and with a specific treatment ranged from 6.1 weeks to 33 months and from 3.1 to 21 months, respectively. Original GPA and GPA-derived scales are valid prognostic tools, but with heterogeneous survival results when compared to each other. More studies are needed to improve scientific evidence of these scales.

Brain metastasis from gastric adenocarcinoma: A large comprehensive population-based cohort study on risk factors and prognosis

Aims

Although brain metastasis from gastric adenocarcinoma (GaC) is rare, it may significantly affect survival and quality of life. The aim of this large, comprehensive, population-based cohort investigation was to investigate factors that were associated with brain metastasis from GaC and to explore the prognostic factors and time-dependent cumulative mortalities among cases with GaC and brain involvement.

Methods

Population-based information on cases with GaC diagnosed from 2010 to 2016 was obtained from a large-scale database. Factors that were associated with brain metastasis were investigated utilizing multivariable logistic regression. Time-dependent tumor-specific mortalities of cases with GaC and brain involvement were then computed utilizing the cumulative incidence functions (CIFs), and mortalities were compared between subgroups utilizing Gray's test. Factors that were associated with death were further evaluated utilizing multivariable Fine-Gray subdistribution hazard regression.

Results

Together, 28,736 eligible cases were included, which comprised 231 (1%) cases with brain metastasis and 10,801 (38%) with metastasis to other sites, encompassing a follow-up of 39,168 person-years. Brain metastasis occurred more often among younger patients (within overall cancers), in cases with stomach cardia tumors, within cases with signet-ring cell carcinoma (within overall cancers), and within cases with positive lymph nodes (within overall tumors); it was less often detected among black people. Brain involvement was associated with more lung and bone metastases. The median survival time of cases having brain metastasis was only 3 months; the 6- and 12-month tumor-specific cumulative mortalities were 57% and 71%, respectively. Among cases with GaC and brain metastasis, those with gastric cardia cancers (when receiving radiotherapy), those undergoing resection, and those receiving chemotherapy had lower mortality risks, while younger patients (when receiving chemotherapy or radiotherapy) and people with positive lymph nodes (when receiving radiotherapy) had higher death hazards.

Conclusion

Among patients with GaC, brain metastasis was correlated with several clinical and pathological variables, including ethnicity, age, cancer histology, location, lymph node involvement, and metastases to other sites. Cases having brain metastasis had poor survival that was correlated with age, cancer location, lymph node metastasis, and management. These findings offer vital clues for individualized patient care and future mechanistic explorations.

External Validation of the Graded Prognostic Assessment in Patients with Brain Metastases from Small Cell Lung Cancer

BACKGROUND

Recently, graded prognostic assessment (GPA) for small cell lung cancer (SCLC) patients with brain metastases has been developed. This includes age, performance status, number of brain metastases and presence of extracranial metastases. The aim of the present study was to validate this four-tiered prognostic score in a European cohort of patients.

METHODS

The retrospective validation study included 180 patients from two centers in Germany and Norway.

RESULTS

Median survival from radiological diagnosis of brain metastases was 7 months. The GPA point sum as continuous variable (0-4 points) was significantly associated with survival (p < 0.001). However, no significant survival difference was observed between patients in the two strata with better survival (3.5-4 and 2.5-3 points, respectively). Long-term survival in the poor prognosis group (0-1 points) was better than expected.

CONCLUSION

This study supports the prognostic impact of all four parameters contributing to the GPA. The original way of grouping the parameters and breaking the final strata did not give optimal results in this cohort. Therefore, additional validation databases from different countries should be created and evaluated.

Treatment of brain metastases from gastrointestinal primaries: Comparing whole-brain radiotherapy and stereotactic radiosurgery in terms of survival

Objective:

The objective of the study was to analyze the clinical features and prognostic factors for survival in patients with brain metastasis (BM) from gastrointestinal primaries treated with whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS).

Methods:

We retrospectively investigated patients with BMs resulting from gastrointestinal primaries who underwent WBRT or SRS. The effects of treatment modalities on overall survival (OS) were calculated by the Kaplan–Meier method.

Results:

WBRT and SRS were applied to 24 and 17 patients, respectively. In the WBRT group, radiotherapy was delivered at 20–30 Gy in 5–10 fractions (fx). In the SRS group, a median dose of 22 Gy (range: 18–27 Gy) was applied in 1–3 fx. At BM diagnosis, all patients had synchronous extracranial metastases which were mostly detected in the lung and liver. Median OS values were 9 months and 4 months in the SRS and WBRT groups, respectively (p=0.005). Karnofsky performance status (KPS) score (≥70 vs. <70), diagnosis-specific graded prognostic index, gastrointestinal (GI) graded prognostic index, cumulative intracranial tumor volume (CITV), controlled systemic disease, and treatment modality (WBRT vs. SBRT) were found to be related with OS.

Conclusion:

In patients with GI cancer-related BMs, SRS should be preferred in those with longer OS expectancy who have controlled extracranial disease, good KPS and CITV values of <10 cm³.

Immunoregulatory mechanism studies of ginseng leaves on lung cancer based on network pharmacology and molecular docking

Panax ginseng is one of the oldest and most generally prescribed herbs in Eastern traditional medicine to treat diseases. Several studies had documented that ginseng leaves have anti-oxidative, anti-inflammatory, and anticancer properties similar to those of ginseng root. The aim of this research was to forecast of the molecular mechanism of ginseng leaves on lung cancer by molecular docking and network pharmacology so as to decipher ginseng leaves' entire mechanism. The compounds associated with ginseng leaves were searched by TCMSP. TCMSP and Swiss Target Prediction databases were used to sort out the potential targets of the main chemical components. Targets were collected from OMIM, PharmGKB, TTD, DrugBank and GeneCards which related to immunity and lung cancer. Ginseng leaves exert its lung cancer suppressive function by regulating the several signaling proteins, such as JUN, STAT3, AKT1, TNF, MAPK1, TP53. GO and KEGG analyses indicated that the immunoreaction against lung cancer by ginseng leaves might be related to response to lipopolysaccharide, response to oxidative stress, PI3K-Akt, MAPK and TNF pathway. Molecular docking analysis demonstrated that hydrogen bonding was interaction's core forms. The results of CCK8 test and qRT-PCR showed that ginseng leaves inhibit cell proliferation and regulates AKT1 and P53 expression in A549. The present study clarifies the mechanism of Ginseng leaves against lung cancer and provides evidence to support its clinical use.