Nomogram prediction of survival in patients with brain metastases from hepatocellular carcinoma treated with whole-brain radiotherapy: a multicenter retrospective study.
The incidence of brain metastasis from hepatocellular carcinoma (HCC) is increasing because of the improved survival outcome of HCC patients, but the prognosis of these patients is extremely poor. HCC patients with brain metastasis were investigated to identify their prognostic factors for overall survival. Patients with brain metastasis from HCC who had been treated with whole-brain radiotherapy (WBRT) in five hospitals were enrolled in the study. The medical records of the patients were reviewed, and the clinical factors were analyzed to identify the prognostic factors for overall survival. Of the total of 97 patients who were enrolled in the study, 83 were male and the median age at the brain metastases was 56.6 years. Motor weakness (43.3 %) and headache (41.2 %) were common presenting symptoms. The median AFP level was 4180 ng/ml, and 81 patients were assessed as belonging to Child-Pugh classification A upon the diagnosis of brain metastasis. WBRT alone in 71 patients, surgery or radiosurgery combined with WBRT as the adjuvant setting in 18 patients, and WBRT as salvage treatment in 8 patients were performed. The median overall survival of the patients was 3.5 months. In the multivariate analysis, the ECOG performance status (PS), Child-Pugh classification, AFP, and treatment aim showed significant association with the overall survival of the patients. Based on these factors, a nomogram predicting the prognosis was developed. The concordance index of the nomogram was 0.74, and the prediction was well calibrated. In conclusion, the survival outcome of patients with brain metastasis from HCC can be predicted with the nomogram constructed from the ECOG PS, Child-Pugh classification, AFP, and treatment aim.
Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.|Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Younghee
Y
Park
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Kyung Su
KS
Kim
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. kyubokim@snu.ac.kr.
Kyubo
K
Kim
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Eui Kyu
EK
Chie
Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
Jin Ho
JH
Kim
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Jae-Sung
JS
Kim
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Tae Hyun
TH
Kim
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Dae Yong
DY
Kim
Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea.
Won Il
WI
Jang
Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea.
Mi-Sook
MS
Kim
Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Tae Ryool
TR
Koo
Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Ah Ram
AR
Chang
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D049451:Nomograms; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Brain metastasis; Hepatocellular carcinoma; Nomogram; Prognostic factor