A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation
Objective Patients with small cell lung cancer (SCLC) have a high risk of developing brain metastases (BM). Prophylactic cranial irradiation (PCI) is a standard therapy for limited-stage SCLC (LS-SCLC) patients who achieved complete or partial response after thoracic chemoradiotherapy (Chemo-RT). Re...
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| Veröffentlicht in: | Strahlentherapie und Onkologie 2023-08, Vol.199 (8), p.727-738 |
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| creator | Liu, Jianjiang Wu, Dongping Shen, Bin Chen, Mengyuan Zhou, Xia Zhang, Peng Qiu, Guoqin Ji, Yongling Du, Xianghui Yang, Yang |
| description | Objective
Patients with small cell lung cancer (SCLC) have a high risk of developing brain metastases (BM). Prophylactic cranial irradiation (PCI) is a standard therapy for limited-stage SCLC (LS-SCLC) patients who achieved complete or partial response after thoracic chemoradiotherapy (Chemo-RT). Recent studies have indicated that a subgroup of patients with a lower risk of BM can avoid PCI, and the present study therefore tries to construct a nomogram to predict the cumulative risk of development of BM in LS-SCLC patients without PCI.
Methods
After screening of 2298 SCLC patients who were treated at the Zhejiang Cancer Hospital from December 2009 to April 2016, a total of 167 consecutive patients with LS-SCLC who received thoracic Chemo-RT without PCI were retrospectively analyzed. The paper analyzed clinical and laboratory factors that may be correlated with BM, such as response to treatment, pretreatment serum neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels, and TNM stage. Thereafter, a nomogram was constructed to predict 3‑ and 5‑year intracranial progression-free survival (IPFS).
Results
Of 167 patients with LS-SCLC, 50 developed subsequent BM. Univariate analysis showed that pretreatment LDH (pre-LDH) ≥ 200 IU/L, an incomplete response to initial chemoradiation, and UICC stage III were positively correlated to a higher risk of BM (
p
|
| doi_str_mv | 10.1007/s00066-023-02073-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2806994816</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2840415542</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-c5b0dbcb6289db6a6fdba66fe2dca5752f84e03cd1264d18dfb8c433e72994443</originalsourceid><addsrcrecordid>eNp9kc9qFTEUxoMo9lp9ARcScONmNP8mM1mW4j8ouFFwFzLJmXtTJ8k1ydT2ZUqfxScz7a0KLoQkh3B-5zsffAg9p-Q1JWR4UwghUnaE8XbJwLvLB2hDBVcdUerrQ7QhdFDdQPvxCD0p5ZwQKoUSj9ERHyjhPVMbdH3y8yamkLbZBFwT3mdw3lZcd4DtGtbFVH8BOPvyDc8p4ykbH3GAako7UHD77RsDsRb8w9cdXnzwFVzX-lvAJZhlwRbas6xxi62JFvIdmdba1qX97moxtnqLbTbRmwX7nI3zTTTFp-jRbJYCz-7rMfry7u3n0w_d2af3H09PzjrLmayd7SfiJjtJNio3SSNnNxkpZ2DOmn7o2TwKINw6yqRwdHTzNFrBOQxMKSEEP0avDrrN0PcVStXBl1vXJkJai2YjkY0cqWzoy3_Q87Tm2Nw1ShBB-16wRrEDZXMqJcOs99kHk680Jfo2PX1IT7f09F16-rINvbiXXqcA7s_I77gawA9Aaa24hfx3939kfwHGaKrI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2840415542</pqid></control><display><type>article</type><title>A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation</title><source>Springer Online Journals Complete</source><creator>Liu, Jianjiang ; Wu, Dongping ; Shen, Bin ; Chen, Mengyuan ; Zhou, Xia ; Zhang, Peng ; Qiu, Guoqin ; Ji, Yongling ; Du, Xianghui ; Yang, Yang</creator><creatorcontrib>Liu, Jianjiang ; Wu, Dongping ; Shen, Bin ; Chen, Mengyuan ; Zhou, Xia ; Zhang, Peng ; Qiu, Guoqin ; Ji, Yongling ; Du, Xianghui ; Yang, Yang</creatorcontrib><description>Objective
Patients with small cell lung cancer (SCLC) have a high risk of developing brain metastases (BM). Prophylactic cranial irradiation (PCI) is a standard therapy for limited-stage SCLC (LS-SCLC) patients who achieved complete or partial response after thoracic chemoradiotherapy (Chemo-RT). Recent studies have indicated that a subgroup of patients with a lower risk of BM can avoid PCI, and the present study therefore tries to construct a nomogram to predict the cumulative risk of development of BM in LS-SCLC patients without PCI.
Methods
After screening of 2298 SCLC patients who were treated at the Zhejiang Cancer Hospital from December 2009 to April 2016, a total of 167 consecutive patients with LS-SCLC who received thoracic Chemo-RT without PCI were retrospectively analyzed. The paper analyzed clinical and laboratory factors that may be correlated with BM, such as response to treatment, pretreatment serum neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels, and TNM stage. Thereafter, a nomogram was constructed to predict 3‑ and 5‑year intracranial progression-free survival (IPFS).
Results
Of 167 patients with LS-SCLC, 50 developed subsequent BM. Univariate analysis showed that pretreatment LDH (pre-LDH) ≥ 200 IU/L, an incomplete response to initial chemoradiation, and UICC stage III were positively correlated to a higher risk of BM (
p
< 0.05). Multivariate analysis identified pretreatment LDH level (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.08–3.34,
p
= 0.026), response to chemoradiation (HR 1.87, 95% CI 1.04–3.34,
p
= 0.035), and UICC stage (HR 6.67, 95% CI 1.03–49.15,
p
= 0.043) as independent predictors for the development of BM. A nomogram model was then established, and areas under the curve of 3‑year and 5‑year IPFS were 0.72 and 0.67, respectively.
Conclusion
The present study has developed an innovative tool that is able to predict the individual cumulative risk for development of BM in LS-SCLC patients without PCI, which is beneficial for providing personalized risk estimates and facilitating the decision to perform PCI.</description><identifier>ISSN: 0179-7158</identifier><identifier>EISSN: 1439-099X</identifier><identifier>DOI: 10.1007/s00066-023-02073-x</identifier><identifier>PMID: 37103529</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Brain ; Brain cancer ; Irradiation ; Lactate dehydrogenase ; Lung cancer ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastasis ; Multivariate analysis ; Nomograms ; Oncology ; Original Article ; Pretreatment ; Radiation therapy ; Radiotherapy ; Risk ; Subgroups</subject><ispartof>Strahlentherapie und Onkologie, 2023-08, Vol.199 (8), p.727-738</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-c5b0dbcb6289db6a6fdba66fe2dca5752f84e03cd1264d18dfb8c433e72994443</cites><orcidid>0000-0001-6088-5435</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00066-023-02073-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00066-023-02073-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37103529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Jianjiang</creatorcontrib><creatorcontrib>Wu, Dongping</creatorcontrib><creatorcontrib>Shen, Bin</creatorcontrib><creatorcontrib>Chen, Mengyuan</creatorcontrib><creatorcontrib>Zhou, Xia</creatorcontrib><creatorcontrib>Zhang, Peng</creatorcontrib><creatorcontrib>Qiu, Guoqin</creatorcontrib><creatorcontrib>Ji, Yongling</creatorcontrib><creatorcontrib>Du, Xianghui</creatorcontrib><creatorcontrib>Yang, Yang</creatorcontrib><title>A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation</title><title>Strahlentherapie und Onkologie</title><addtitle>Strahlenther Onkol</addtitle><addtitle>Strahlenther Onkol</addtitle><description>Objective
Patients with small cell lung cancer (SCLC) have a high risk of developing brain metastases (BM). Prophylactic cranial irradiation (PCI) is a standard therapy for limited-stage SCLC (LS-SCLC) patients who achieved complete or partial response after thoracic chemoradiotherapy (Chemo-RT). Recent studies have indicated that a subgroup of patients with a lower risk of BM can avoid PCI, and the present study therefore tries to construct a nomogram to predict the cumulative risk of development of BM in LS-SCLC patients without PCI.
Methods
After screening of 2298 SCLC patients who were treated at the Zhejiang Cancer Hospital from December 2009 to April 2016, a total of 167 consecutive patients with LS-SCLC who received thoracic Chemo-RT without PCI were retrospectively analyzed. The paper analyzed clinical and laboratory factors that may be correlated with BM, such as response to treatment, pretreatment serum neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels, and TNM stage. Thereafter, a nomogram was constructed to predict 3‑ and 5‑year intracranial progression-free survival (IPFS).
Results
Of 167 patients with LS-SCLC, 50 developed subsequent BM. Univariate analysis showed that pretreatment LDH (pre-LDH) ≥ 200 IU/L, an incomplete response to initial chemoradiation, and UICC stage III were positively correlated to a higher risk of BM (
p
< 0.05). Multivariate analysis identified pretreatment LDH level (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.08–3.34,
p
= 0.026), response to chemoradiation (HR 1.87, 95% CI 1.04–3.34,
p
= 0.035), and UICC stage (HR 6.67, 95% CI 1.03–49.15,
p
= 0.043) as independent predictors for the development of BM. A nomogram model was then established, and areas under the curve of 3‑year and 5‑year IPFS were 0.72 and 0.67, respectively.
Conclusion
The present study has developed an innovative tool that is able to predict the individual cumulative risk for development of BM in LS-SCLC patients without PCI, which is beneficial for providing personalized risk estimates and facilitating the decision to perform PCI.</description><subject>Brain</subject><subject>Brain cancer</subject><subject>Irradiation</subject><subject>Lactate dehydrogenase</subject><subject>Lung cancer</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Multivariate analysis</subject><subject>Nomograms</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pretreatment</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Risk</subject><subject>Subgroups</subject><issn>0179-7158</issn><issn>1439-099X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kc9qFTEUxoMo9lp9ARcScONmNP8mM1mW4j8ouFFwFzLJmXtTJ8k1ydT2ZUqfxScz7a0KLoQkh3B-5zsffAg9p-Q1JWR4UwghUnaE8XbJwLvLB2hDBVcdUerrQ7QhdFDdQPvxCD0p5ZwQKoUSj9ERHyjhPVMbdH3y8yamkLbZBFwT3mdw3lZcd4DtGtbFVH8BOPvyDc8p4ykbH3GAako7UHD77RsDsRb8w9cdXnzwFVzX-lvAJZhlwRbas6xxi62JFvIdmdba1qX97moxtnqLbTbRmwX7nI3zTTTFp-jRbJYCz-7rMfry7u3n0w_d2af3H09PzjrLmayd7SfiJjtJNio3SSNnNxkpZ2DOmn7o2TwKINw6yqRwdHTzNFrBOQxMKSEEP0avDrrN0PcVStXBl1vXJkJai2YjkY0cqWzoy3_Q87Tm2Nw1ShBB-16wRrEDZXMqJcOs99kHk680Jfo2PX1IT7f09F16-rINvbiXXqcA7s_I77gawA9Aaa24hfx3939kfwHGaKrI</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Liu, Jianjiang</creator><creator>Wu, Dongping</creator><creator>Shen, Bin</creator><creator>Chen, Mengyuan</creator><creator>Zhou, Xia</creator><creator>Zhang, Peng</creator><creator>Qiu, Guoqin</creator><creator>Ji, Yongling</creator><creator>Du, Xianghui</creator><creator>Yang, Yang</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6088-5435</orcidid></search><sort><creationdate>20230801</creationdate><title>A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation</title><author>Liu, Jianjiang ; Wu, Dongping ; Shen, Bin ; Chen, Mengyuan ; Zhou, Xia ; Zhang, Peng ; Qiu, Guoqin ; Ji, Yongling ; Du, Xianghui ; Yang, Yang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-c5b0dbcb6289db6a6fdba66fe2dca5752f84e03cd1264d18dfb8c433e72994443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Brain</topic><topic>Brain cancer</topic><topic>Irradiation</topic><topic>Lactate dehydrogenase</topic><topic>Lung cancer</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Multivariate analysis</topic><topic>Nomograms</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pretreatment</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Risk</topic><topic>Subgroups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Jianjiang</creatorcontrib><creatorcontrib>Wu, Dongping</creatorcontrib><creatorcontrib>Shen, Bin</creatorcontrib><creatorcontrib>Chen, Mengyuan</creatorcontrib><creatorcontrib>Zhou, Xia</creatorcontrib><creatorcontrib>Zhang, Peng</creatorcontrib><creatorcontrib>Qiu, Guoqin</creatorcontrib><creatorcontrib>Ji, Yongling</creatorcontrib><creatorcontrib>Du, Xianghui</creatorcontrib><creatorcontrib>Yang, Yang</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Strahlentherapie und Onkologie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Jianjiang</au><au>Wu, Dongping</au><au>Shen, Bin</au><au>Chen, Mengyuan</au><au>Zhou, Xia</au><au>Zhang, Peng</au><au>Qiu, Guoqin</au><au>Ji, Yongling</au><au>Du, Xianghui</au><au>Yang, Yang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation</atitle><jtitle>Strahlentherapie und Onkologie</jtitle><stitle>Strahlenther Onkol</stitle><addtitle>Strahlenther Onkol</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>199</volume><issue>8</issue><spage>727</spage><epage>738</epage><pages>727-738</pages><issn>0179-7158</issn><eissn>1439-099X</eissn><abstract>Objective
Patients with small cell lung cancer (SCLC) have a high risk of developing brain metastases (BM). Prophylactic cranial irradiation (PCI) is a standard therapy for limited-stage SCLC (LS-SCLC) patients who achieved complete or partial response after thoracic chemoradiotherapy (Chemo-RT). Recent studies have indicated that a subgroup of patients with a lower risk of BM can avoid PCI, and the present study therefore tries to construct a nomogram to predict the cumulative risk of development of BM in LS-SCLC patients without PCI.
Methods
After screening of 2298 SCLC patients who were treated at the Zhejiang Cancer Hospital from December 2009 to April 2016, a total of 167 consecutive patients with LS-SCLC who received thoracic Chemo-RT without PCI were retrospectively analyzed. The paper analyzed clinical and laboratory factors that may be correlated with BM, such as response to treatment, pretreatment serum neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) levels, and TNM stage. Thereafter, a nomogram was constructed to predict 3‑ and 5‑year intracranial progression-free survival (IPFS).
Results
Of 167 patients with LS-SCLC, 50 developed subsequent BM. Univariate analysis showed that pretreatment LDH (pre-LDH) ≥ 200 IU/L, an incomplete response to initial chemoradiation, and UICC stage III were positively correlated to a higher risk of BM (
p
< 0.05). Multivariate analysis identified pretreatment LDH level (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.08–3.34,
p
= 0.026), response to chemoradiation (HR 1.87, 95% CI 1.04–3.34,
p
= 0.035), and UICC stage (HR 6.67, 95% CI 1.03–49.15,
p
= 0.043) as independent predictors for the development of BM. A nomogram model was then established, and areas under the curve of 3‑year and 5‑year IPFS were 0.72 and 0.67, respectively.
Conclusion
The present study has developed an innovative tool that is able to predict the individual cumulative risk for development of BM in LS-SCLC patients without PCI, which is beneficial for providing personalized risk estimates and facilitating the decision to perform PCI.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37103529</pmid><doi>10.1007/s00066-023-02073-x</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-6088-5435</orcidid></addata></record> |
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| source | Springer Online Journals Complete |
| subjects | Brain Brain cancer Irradiation Lactate dehydrogenase Lung cancer Medical prognosis Medicine Medicine & Public Health Metastasis Multivariate analysis Nomograms Oncology Original Article Pretreatment Radiation therapy Radiotherapy Risk Subgroups |
| title | A nomogram to predict the cumulative risk for brain metastases in patients with limited-stage small cell lung cancer without prophylactic cranial irradiation |
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