Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement.
OBJECTIVE
To explore the role of expanded assessment of metastatic extracranial organ involvement, as well as albumin and lactate dehydrogenase (LDH), i.e. surrogates of disease extent, in survival prediction models for patients with brain metastases.


METHODS
A retrospective analysis of 189 patients treated with whole brain radiotherapy was carried out. Uni- and multivariate analyses included recursive partitioning analysis classes, basic score for brain metastases and diagnosis-specific graded prognostic assessment (DS-GPA).


RESULTS
Elevated LDH correlated significantly with extracranial organ involvement, low albumin with primary tumour type and primary tumour control. Elevated LDH, low albumin and a combination of both correlated significantly with overall survival. LDH, albumin and the number of extracranial organs involved (none, one, two or more harbouring metastases) were independent prognostic factors in multivariate analyses (if added to the three established scores mentioned above and also if added to individual parameters such as age, performance status, etc.). A combination of these three new prognostic factors predicted very short survival (median 0.7 months if all three were present).


CONCLUSIONS
We have previously defined patient groups in whom foregoing radiotherapy was unlikely to compromise survival. These were patients with a DS-GPA score of 0-1.5 points and age ≥75 years or Karnofsky performance status ≤50 or uncontrolled primary tumour with extracranial metastases to at least two organs. Patients with a combination of three new adverse features (elevated LDH plus low albumin plus extracranial metastases to at least two organs) might also be considered for best supportive care. Furthermore, it appears warranted to study whether scores such as DS-GPA can be optimised by integrating information on these three parameters.
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. Electronic address: carsten.nieder@nlsh.no.
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Nieder
Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
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Marienhagen
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
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Dalhaug
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
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Aandahl
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
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Haukland
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
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Pawinski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009362:Neoplasm Metastasis; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D055815:Young Adult
D012709:Serum Albumin; D007770:L-Lactate Dehydrogenase
Albumin; best supportive care; brain metastases; lactate dehydrogenase; prognostic factors; radiotherapy