External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation

Klaus Müller; Guido Henke; Inge Compter; André O von Bueren; Carsten Friedrich; Geert Janssens; Christof M Kramm; Thomas Hundsberger; Frank Paulsen; Rolf-Dieter Kortmann; Isabella Zwiener; Brigitta G Baumert

doi:10.1016/j.prro.2014.10.001

External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation

Klaus Müller^*, Guido Henke, Inge Compter, André O von Bueren, Carsten Friedrich, Geert Janssens, Christof M Kramm, Thomas Hundsberger, Frank Paulsen, Rolf-Dieter Kortmann, Isabella Zwiener, Brigitta G Baumert

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: We aimed to validate a controversial prognostic model for the survival of relapsed malignant glioma patients after reirradiation with an independent, multicentric patient cohort.

METHODS AND MATERIALS: A total of 165 malignant glioma patients underwent reirradiation at 4 different institutions between 1994 and 2012. Twenty-two patients had a good (score 1), 44 had a moderate (score 2), and 99 had a poor prognosis (score 3 or 4). Four statistical methods were used to validate the prognostic model: First, we compared survival according to prognostic group in the construction and the validation cohort by visual comparison of the respective Kaplan-Meier plots. Second, discrimination was quantified by calculating hazard ratios for death for each prognostic group, with the worst prognostic group serving as the reference. Calibration was assessed by a calibration plot for the time point 12 months after reirradiation. Finally, we compared the predictive performance of the score and a hypothetical prognostic model ignoring all predictor variables over time by means of a prediction error curve.

RESULTS: On visual validation, the survival curves of the 3 patient groups with good, moderate, and poor prognoses nicely separated from each other. Median survival rates after reirradiation were 17.9, 9.0, and 7.7 months in the patient groups with good, moderate, and poor prognosis, respectively. Hazard ratios confirmed satisfactory discrimination. Calibration was satisfactory for all and most accurate for the worst prognostic group. The score improved the prognostic performance in comparison to the "zero-model."

CONCLUSIONS: We successfully validated a prognostic model for the survival of malignant glioma patients after reirradiation with a multicentric, independent dataset. Being reliable and easy to handle, the model can be useful in personalized patient counseling and clinical decision-making.

Original language	English
Pages (from-to)	e143-e150
Journal	Practical radiation oncology
Volume	5
Issue number	3
Early online date	18 Nov 2014
DOIs	https://doi.org/10.1016/j.prro.2014.10.001
Publication status	Published - 2015

Keywords

Adolescent
Adult
Aged
Brain Neoplasms
Calibration
Child
Cohort Studies
Glioma
Humans
Kaplan-Meier Estimate
Middle Aged
Models, Theoretical
Prognosis
Re-Irradiation
Survival Rate
Young Adult

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10.1016/j.prro.2014.10.001

Cite this

Müller, K., Henke, G., Compter, I., von Bueren, A. O., Friedrich, C., Janssens, G., Kramm, C. M., Hundsberger, T., Paulsen, F., Kortmann, R.-D., Zwiener, I., & Baumert, B. G. (2015). External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation. Practical radiation oncology, 5(3), e143-e150. https://doi.org/10.1016/j.prro.2014.10.001

@article{ec86a47ba78d4ac4b5d6f1cb0414f16a,

title = "External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation",

abstract = "PURPOSE: We aimed to validate a controversial prognostic model for the survival of relapsed malignant glioma patients after reirradiation with an independent, multicentric patient cohort.METHODS AND MATERIALS: A total of 165 malignant glioma patients underwent reirradiation at 4 different institutions between 1994 and 2012. Twenty-two patients had a good (score 1), 44 had a moderate (score 2), and 99 had a poor prognosis (score 3 or 4). Four statistical methods were used to validate the prognostic model: First, we compared survival according to prognostic group in the construction and the validation cohort by visual comparison of the respective Kaplan-Meier plots. Second, discrimination was quantified by calculating hazard ratios for death for each prognostic group, with the worst prognostic group serving as the reference. Calibration was assessed by a calibration plot for the time point 12 months after reirradiation. Finally, we compared the predictive performance of the score and a hypothetical prognostic model ignoring all predictor variables over time by means of a prediction error curve.RESULTS: On visual validation, the survival curves of the 3 patient groups with good, moderate, and poor prognoses nicely separated from each other. Median survival rates after reirradiation were 17.9, 9.0, and 7.7 months in the patient groups with good, moderate, and poor prognosis, respectively. Hazard ratios confirmed satisfactory discrimination. Calibration was satisfactory for all and most accurate for the worst prognostic group. The score improved the prognostic performance in comparison to the {"}zero-model.{"}CONCLUSIONS: We successfully validated a prognostic model for the survival of malignant glioma patients after reirradiation with a multicentric, independent dataset. Being reliable and easy to handle, the model can be useful in personalized patient counseling and clinical decision-making.",

keywords = "Adolescent, Adult, Aged, Brain Neoplasms, Calibration, Child, Cohort Studies, Glioma, Humans, Kaplan-Meier Estimate, Middle Aged, Models, Theoretical, Prognosis, Re-Irradiation, Survival Rate, Young Adult",

author = "Klaus M{\"u}ller and Guido Henke and Inge Compter and {von Bueren}, {Andr{\'e} O} and Carsten Friedrich and Geert Janssens and Kramm, {Christof M} and Thomas Hundsberger and Frank Paulsen and Rolf-Dieter Kortmann and Isabella Zwiener and Baumert, {Brigitta G}",

year = "2015",

doi = "10.1016/j.prro.2014.10.001",

language = "English",

volume = "5",

pages = "e143--e150",

journal = "Practical radiation oncology",

issn = "1879-8500",

publisher = "Elsevier Science",

number = "3",

}

Müller, K, Henke, G, Compter, I, von Bueren, AO, Friedrich, C, Janssens, G, Kramm, CM, Hundsberger, T, Paulsen, F, Kortmann, R-D, Zwiener, I & Baumert, BG 2015, 'External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation', Practical radiation oncology, vol. 5, no. 3, pp. e143-e150. https://doi.org/10.1016/j.prro.2014.10.001

TY - JOUR

T1 - External validation of a prognostic model estimating the survival of patients with recurrent high-grade gliomas after reirradiation

AU - Müller, Klaus

AU - Henke, Guido

AU - Compter, Inge

AU - von Bueren, André O

AU - Friedrich, Carsten

AU - Janssens, Geert

AU - Kramm, Christof M

AU - Hundsberger, Thomas

AU - Paulsen, Frank

AU - Kortmann, Rolf-Dieter

AU - Zwiener, Isabella

AU - Baumert, Brigitta G

PY - 2015

Y1 - 2015

N2 - PURPOSE: We aimed to validate a controversial prognostic model for the survival of relapsed malignant glioma patients after reirradiation with an independent, multicentric patient cohort.METHODS AND MATERIALS: A total of 165 malignant glioma patients underwent reirradiation at 4 different institutions between 1994 and 2012. Twenty-two patients had a good (score 1), 44 had a moderate (score 2), and 99 had a poor prognosis (score 3 or 4). Four statistical methods were used to validate the prognostic model: First, we compared survival according to prognostic group in the construction and the validation cohort by visual comparison of the respective Kaplan-Meier plots. Second, discrimination was quantified by calculating hazard ratios for death for each prognostic group, with the worst prognostic group serving as the reference. Calibration was assessed by a calibration plot for the time point 12 months after reirradiation. Finally, we compared the predictive performance of the score and a hypothetical prognostic model ignoring all predictor variables over time by means of a prediction error curve.RESULTS: On visual validation, the survival curves of the 3 patient groups with good, moderate, and poor prognoses nicely separated from each other. Median survival rates after reirradiation were 17.9, 9.0, and 7.7 months in the patient groups with good, moderate, and poor prognosis, respectively. Hazard ratios confirmed satisfactory discrimination. Calibration was satisfactory for all and most accurate for the worst prognostic group. The score improved the prognostic performance in comparison to the "zero-model."CONCLUSIONS: We successfully validated a prognostic model for the survival of malignant glioma patients after reirradiation with a multicentric, independent dataset. Being reliable and easy to handle, the model can be useful in personalized patient counseling and clinical decision-making.

AB - PURPOSE: We aimed to validate a controversial prognostic model for the survival of relapsed malignant glioma patients after reirradiation with an independent, multicentric patient cohort.METHODS AND MATERIALS: A total of 165 malignant glioma patients underwent reirradiation at 4 different institutions between 1994 and 2012. Twenty-two patients had a good (score 1), 44 had a moderate (score 2), and 99 had a poor prognosis (score 3 or 4). Four statistical methods were used to validate the prognostic model: First, we compared survival according to prognostic group in the construction and the validation cohort by visual comparison of the respective Kaplan-Meier plots. Second, discrimination was quantified by calculating hazard ratios for death for each prognostic group, with the worst prognostic group serving as the reference. Calibration was assessed by a calibration plot for the time point 12 months after reirradiation. Finally, we compared the predictive performance of the score and a hypothetical prognostic model ignoring all predictor variables over time by means of a prediction error curve.RESULTS: On visual validation, the survival curves of the 3 patient groups with good, moderate, and poor prognoses nicely separated from each other. Median survival rates after reirradiation were 17.9, 9.0, and 7.7 months in the patient groups with good, moderate, and poor prognosis, respectively. Hazard ratios confirmed satisfactory discrimination. Calibration was satisfactory for all and most accurate for the worst prognostic group. The score improved the prognostic performance in comparison to the "zero-model."CONCLUSIONS: We successfully validated a prognostic model for the survival of malignant glioma patients after reirradiation with a multicentric, independent dataset. Being reliable and easy to handle, the model can be useful in personalized patient counseling and clinical decision-making.

KW - Adolescent

KW - Adult

KW - Aged

KW - Brain Neoplasms

KW - Calibration

KW - Child

KW - Cohort Studies

KW - Glioma

KW - Humans

KW - Kaplan-Meier Estimate

KW - Middle Aged

KW - Models, Theoretical

KW - Prognosis

KW - Re-Irradiation

KW - Survival Rate

KW - Young Adult

U2 - 10.1016/j.prro.2014.10.001

DO - 10.1016/j.prro.2014.10.001

M3 - Article

C2 - 25424325

SN - 1879-8500

VL - 5

SP - e143-e150

JO - Practical radiation oncology

JF - Practical radiation oncology

IS - 3

ER -