title: A nomogram for individualized estimation of survival among patients with brain metastasis.
abstract: OBJECTIVE
  An estimated 24%-45% of patients with cancer develop brain metastases. Individualized estimation of survival for patients with brain metastasis could be useful for counseling patients on clinical outcomes and prognosis.
  
  
  METHODS
  De-identified data for 2367 patients with brain metastasis from 7 Radiation Therapy Oncology Group randomized trials were used to develop and internally validate a prognostic nomogram for estimation of survival among patients with brain metastasis. The prognostic accuracy for survival from 3 statistical approaches (Cox proportional hazards regression, recursive partitioning analysis [RPA], and random survival forests) was calculated using the concordance index. A nomogram for 12-month, 6-month, and median survival was generated using the most parsimonious model.
  
  
  RESULTS
  The majority of patients had lung cancer, controlled primary disease, no surgery, Karnofsky performance score (KPS) ≥ 70, and multiple brain metastases and were in RPA class II or had a Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) score of 1.25-2.5. The overall median survival was 136 days (95% confidence interval, 126-144 days). We built the nomogram using the model that included primary site and histology, status of primary disease, metastatic spread, age, KPS, and number of brain lesions. The potential use of individualized survival estimation is demonstrated by showing the heterogeneous distribution of the individual 12-month survival in each RPA class or DS-GPA score group.
  
  
  CONCLUSIONS
  Our nomogram provides individualized estimates of survival, compared with current RPA and DS-GPA group estimates. This tool could be useful for counseling patients with respect to clinical outcomes and prognosis.
authors.affiliation: Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106-5065, USA. jsb42@case.edu
authors.forename: Jill S
authors.initials: JS
authors.lastname: Barnholtz-Sloan
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Sloan
authors.forename: Jaime
authors.initials: J
authors.lastname: Vengoechea
authors.forename: Meihua
authors.initials: M
authors.lastname: Wang
authors.forename: James J
authors.initials: JJ
authors.lastname: Dignam
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.forename: Paul W
authors.initials: PW
authors.lastname: Sperduto
authors.forename: Minesh P
authors.initials: MP
authors.lastname: Mehta
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology*; D049451:Nomograms; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate