Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025
Evaluation of GPA, molGPA and prognostic factors in melanoma brain metastases: a single-center study.
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Philippi Jens Christian, Mittenbacher Niklas, Vordermark Dirk, Medenwald Daniel, Müller Jörg Andreas
Аннотация
BACKGROUND: Malignant melanoma ranks among the leading causes of brain metastases (BM). The Graded Prognostic Assessment (GPA) and the melanoma-specific molecular GPA (molGPA) are well-established prognostic tools that help estimate survival and guide therapeutic decisions. This single-center, retrospective clinical study aimed to evaluate prognostic factors for overall survival (OS), intracranial tumor control (IC), and intracranial progression-free survival (IPFS), as well as GPA and molGPA within a real-world clinical setting.
METHODS: Patients with melanoma-associated BM who underwent radiotherapy (RT) between January 2016 and December 2023 were included. Study endpoints included OS, IC, and IPFS, with OS and IPFS analyzed across the entire cohort (n = 59) and IC was evaluated in cases with follow-up imaging (n = 47).
RESULTS: The median survival of all patients was 6.9 months (IQR 2.2; 23.6). Regarding OS, three predictive factors were significantly associated with the survival probability: a Karnofsky performance status index (KPS) <70 (p = 0.003), a GPA score of 0-1.0 versus 1.5-4.0 (p = 0.002) and a molGPA score of 0-1.0 versus 1.5-4.0 (p= 0.034). Intracranial progression-free survival was significantly decreased in patients with KPS <70 (p = 0.01), multiple brain metastases (p = 0.036), and GPA scores of 0-1.0 (p = 0.011).
CONCLUSIONS: Both GPA and molGPA were validated as significant predictors of OS in patients with melanoma-associated BM. However, GPA emerged as the sole score significantly associated with both OS and IPFS, suggesting a potential advantage in its clinical utility. The validation of GPA and molGPA as significant predictors for OS in a real clinical setting support their use in guiding treatment recommendations.
METHODS: Patients with melanoma-associated BM who underwent radiotherapy (RT) between January 2016 and December 2023 were included. Study endpoints included OS, IC, and IPFS, with OS and IPFS analyzed across the entire cohort (n = 59) and IC was evaluated in cases with follow-up imaging (n = 47).
RESULTS: The median survival of all patients was 6.9 months (IQR 2.2; 23.6). Regarding OS, three predictive factors were significantly associated with the survival probability: a Karnofsky performance status index (KPS) <70 (p = 0.003), a GPA score of 0-1.0 versus 1.5-4.0 (p = 0.002) and a molGPA score of 0-1.0 versus 1.5-4.0 (p= 0.034). Intracranial progression-free survival was significantly decreased in patients with KPS <70 (p = 0.01), multiple brain metastases (p = 0.036), and GPA scores of 0-1.0 (p = 0.011).
CONCLUSIONS: Both GPA and molGPA were validated as significant predictors of OS in patients with melanoma-associated BM. However, GPA emerged as the sole score significantly associated with both OS and IPFS, suggesting a potential advantage in its clinical utility. The validation of GPA and molGPA as significant predictors for OS in a real clinical setting support their use in guiding treatment recommendations.