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30-day mortality in patients treated for brain metastases: extracranial causes dominate

BACKGROUND: Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefull...

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Autores principales: Nieder, Carsten, Stanisavljevic, Luka, Aanes, Siv Gyda, Mannsåker, Bård, Haukland, Ellinor Christin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097068/
https://www.ncbi.nlm.nih.gov/pubmed/35551618
http://dx.doi.org/10.1186/s13014-022-02062-x
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author Nieder, Carsten
Stanisavljevic, Luka
Aanes, Siv Gyda
Mannsåker, Bård
Haukland, Ellinor Christin
author_facet Nieder, Carsten
Stanisavljevic, Luka
Aanes, Siv Gyda
Mannsåker, Bård
Haukland, Ellinor Christin
author_sort Nieder, Carsten
collection PubMed
description BACKGROUND: Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. METHODS: Retrospective analysis (2011–2021) of patients treated for brain metastases with different approaches. Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. RESULTS: The cause of death was unrelated to brain metastases in 61%. Treatment-related death (grade 5 toxicity) did not occur. Completely unexpected death was not observed, e.g. accident, suicide or sudden cardiac death. Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 3–6 points) and a point sum was calculated for each patient. The point sum ranged from 0 (no risk factors for death within 30 days present) to 30. The results can be grouped into 3 or 4 risk categories. Eighty-three percent of patients in the highest risk group (> 16 points) died within 30 days, and none survived for more than 2 months. However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. CONCLUSION: Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. We were able to develop a multifactorial prediction model. However, the model’s performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings.
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spelling pubmed-90970682022-05-13 30-day mortality in patients treated for brain metastases: extracranial causes dominate Nieder, Carsten Stanisavljevic, Luka Aanes, Siv Gyda Mannsåker, Bård Haukland, Ellinor Christin Radiat Oncol Research BACKGROUND: Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. METHODS: Retrospective analysis (2011–2021) of patients treated for brain metastases with different approaches. Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. RESULTS: The cause of death was unrelated to brain metastases in 61%. Treatment-related death (grade 5 toxicity) did not occur. Completely unexpected death was not observed, e.g. accident, suicide or sudden cardiac death. Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 3–6 points) and a point sum was calculated for each patient. The point sum ranged from 0 (no risk factors for death within 30 days present) to 30. The results can be grouped into 3 or 4 risk categories. Eighty-three percent of patients in the highest risk group (> 16 points) died within 30 days, and none survived for more than 2 months. However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. CONCLUSION: Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. We were able to develop a multifactorial prediction model. However, the model’s performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings. BioMed Central 2022-05-12 /pmc/articles/PMC9097068/ /pubmed/35551618 http://dx.doi.org/10.1186/s13014-022-02062-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nieder, Carsten
Stanisavljevic, Luka
Aanes, Siv Gyda
Mannsåker, Bård
Haukland, Ellinor Christin
30-day mortality in patients treated for brain metastases: extracranial causes dominate
title 30-day mortality in patients treated for brain metastases: extracranial causes dominate
title_full 30-day mortality in patients treated for brain metastases: extracranial causes dominate
title_fullStr 30-day mortality in patients treated for brain metastases: extracranial causes dominate
title_full_unstemmed 30-day mortality in patients treated for brain metastases: extracranial causes dominate
title_short 30-day mortality in patients treated for brain metastases: extracranial causes dominate
title_sort 30-day mortality in patients treated for brain metastases: extracranial causes dominate
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097068/
https://www.ncbi.nlm.nih.gov/pubmed/35551618
http://dx.doi.org/10.1186/s13014-022-02062-x
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