title: Analysis of prognostic factors and comparison of prognostic index scores in patients with brain metastases after whole-brain radiotherapy.
abstract: OBJECTIVE
  Brain metastases (BMs) are typically associated with poor patient prognosis. Radiation therapy remains the primary treatment for BMs, and patient's prognosis is affected by many factors. The aim of this study was to identify prognostic factors and to compare prognostic index scores in patients with BMs who received whole-brain radiotherapy (WBRT).
  
  
  METHODS
  A retrospective prognostic study was conducted in 125 patients with BMs who underwent WBRT between Jan 2008 and Jul 2011. The significance of prognostic variables with regard to survival was determined using univariate and multivariate analyses. A prognostic index (PI) was established based on Cox regression analysis and subgrouping values. The recursive partitioning analysis classes (RPA), basic score for brain metastases (BS-BM), Graded Prognostic Assessment index (GPA), and PI were assessed with regard to prognosis.
  
  
  RESULTS
  The median survival time was 213 days (7.1 months). In the univariate analysis of the test group, survival was significantly associated with Karnofsky performance status (KPS) score, the number of BMs, the presence of extracranial metastases, primary tumor status and the number of involved extracranial organs. The multivariate analysis showed that the KPS score (P = 0.002, Wald = 9.700), presence of extracranial metastases (P = 0.018, Wald = 5.604) and primary tumor status (P = 0.001, Wald = 10.212) were significantly correlated with overall survival. RPA, BS-BM and GPA were all closely related to prognosis, as determined using a log-rank test. In predicting the 3- and 6-month survival for patients, the PI was superior to the other three modes.
  
  
  CONCLUSIONS
  The three indexes, RPA, BS-BM and GPA, are valid prognostic index models; however, the PI model was the most powerful.
authors: Department of Radiotherapy, Changzhou Tumor Hospital, Soochow University Changzhou 213001, China.
authors: Judong
authors: J
authors: Luo
authors: Department of Radiation Oncology, Minhang Branch of Cancer Hospital of Fudan University Shanghai 200240, China.
authors: Hong
authors: H
authors: Zhu
authors: Department of Radiotherapy, Changzhou Tumor Hospital, Soochow University Changzhou 213001, China.
authors: Yiting
authors: Y
authors: Tang
authors: Department of Radiation Oncology, Minhang Branch of Cancer Hospital of Fudan University Shanghai 200240, China.
authors: Honglin
authors: H
authors: Wang
authors: Department of Radiotherapy, Changzhou Tumor Hospital, Soochow University Changzhou 213001, China.
authors: Xifa
authors: X
authors: Zhou
authors: Department of Radiotherapy, Changzhou Tumor Hospital, Soochow University Changzhou 213001, China.
authors: Xujing
authors: X
authors: Lu
authors: School of Radiation Medicine and Protection and Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, Medical College of Soochow University Suzhou 215123, China ; Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions and School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University Suzhou 215123, China.
authors: Shuyu
authors: S
authors: Zhang
authors: Department of Radiation Oncology, Minhang Branch of Cancer Hospital of Fudan University Shanghai 200240, China.
authors: Yunhai
authors: Y
authors: Li
keywords: Neoplasms; brain metastases; prognosis; prognostic index scores; whole-brain radiotherapy