# Prognostic Factors and Impact of Therapeutic Intervention in Patients With Brain Metastases at the Initial Presentation

## TL;DR

This study examines factors affecting survival in cancer patients with brain metastases at diagnosis and evaluates the impact of various treatments.

## Contribution

The study identifies RPA class, GPS score, and targeted therapy as key prognostic factors in brain metastases patients.

## Key findings

- Median overall survival was 7.7 months, with some patients surviving over 24 months post-WBRT.
- RPA class 2, GPS of 0, and targeted therapy were linked to better survival outcomes.
- WBRT did not significantly affect prognosis in patients receiving chemotherapy.

## Abstract

Background

Studies investigating the normative characteristics and prognosis of patients diagnosed with brain metastases (BMs) at the onset of cancer are scarce. Therefore, we analyzed real-world treatment options.

Methodology

This retrospective study enrolled 112 patients newly diagnosed with BM between May 2006 and October 2021. The variables examined included patients’ age, sex, recurrence split analysis, Glasgow prognostic score (GPS), number of lesions, tumor size, peripheral brain tumor edema, targeted therapy, supportive care, chemotherapy, and date of onset. Prognostic factors were assessed using recursive partitioning analysis (RPA), graded prognostic assessment (GPA) scores, and GPS scoring, with magnetic resonance imaging (MRI) and computed tomography (CT) studies. Primary treatment comprised whole-brain radiotherapy (WBRT), with regular follow-up.

Results

Data from 112 survivors were analyzed, revealing a median overall survival time (MST) of 7.7 months, with some patients surviving beyond 24 months post-WBRT. Univariate analysis revealed associations between MST and RPA class, GPS, and treatment modalities (including targeted therapy and chemotherapy). RPA class 2, GPS of 0, and targeted therapy were identified as predictors of better prognosis in the multivariate analysis. In the subgroup not receiving chemotherapy, no significant difference in prognosis was seen between groups with or without WBRT.

Conclusions

Alongside RPA, scores indicating chronic inflammatory changes, including GPS, were confirmed as crucial prognostic factors. Moreover, treatment with molecularly targeted drugs correlated with favorable prognoses. The treatment-naïve group exhibited poorer prognoses, and WBRT was not deemed a significant prognostic factor in the chemotherapy group.