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. 2025 Aug 11;15(1):29446.
doi: 10.1038/s41598-025-15635-z.

Melanoma GPA as a novel prognostic scoring model based on initial brain metastasis velocity

Yibin Zeng #  1   2 , Feifei Lin #  1 , Hui Li #  1 , Qian Wu  2 , Ting Zhang  1 , Jianshu Chen  1 , Yifan Wang  1 , Jing Lin  3 , Lirui Tang  1 , Yu Chen  3 , Peicheng Lin  4 , Jinluan Li  5
Affiliations

Melanoma GPA as a novel prognostic scoring model based on initial brain metastasis velocity

Yibin Zeng et al. Sci Rep. .

Abstract

Upon initial presentation, initial brain metastasis velocity (iBMV) is a prognostic factor for patients with brain metastases (BMs). Based on this metric, this study validated the predictive value of iBMV and introduced a Graded Prognostic Assessment (GPA)-derived scale known as melanoma-GPA. We conducted a retrospective cohort study and enrolled patients diagnosed with malignant melanoma brain metastases (MBMs) between December 2010 and February 2023. We performed univariate and multivariate Cox regression analyses to identify prognostic factors affecting overall survival (OS). A novel prognostic scoring model was derived using these factors, then melanoma-GPA and GPA predictive capabilities were assessed and compared. We enrolled 111 patients with a median OS and iBMV of 11.80 months and 2.27, respectively. The Kaplan-Meier curves showed that patients with iBMV ≤ 2.27 have better prognostic performance (P < 0.001). Multivariate analysis showed that iBMV (P = 0.035), Karnofsky Performance Status (P < 0.001), serum lactate dehydrogenase (P = 0.028), serum albumin (P = 0.041), and the systemic immune-inflammation index (P = 0.042) were independent predictors of OS. Subsequently, we established the melanoma-GPA. After risk stratification, the low-risk group had significantly longer survival than the high-risk group (17.7 vs. 7.9 months). In addition, over 3 years, the melanoma-GPA area under the curve (AUC) values were superior to GPA AUC values, indicating that melanoma-GPA has greater predictive accuracy. This study has shown that iBMV is a prognostic indicator in MBMs. Based on this factor, we established the Melanoma-GPA to comprehensively and objectively assess the prognosis of MBMs.

Keywords: Brain metastasis; Initial brain metastasis velocity; Malignant melanoma; Prognosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This is a retrospective study and which was conducted in accordance with the 1964 Declaration of Helsinki and International Conference on Harmonization of Good Clinical Practice Tripartite guidelines. This clinical study was approved by the Ethics Committee of Fujian Cancer Hospital Fuzhou, China (No. K2023-030-01). Due to the retrospective nature of the study, Institutional Review Board waived the need of obtaining informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart depicting the overall design of the study.
Fig. 2
Fig. 2
Clinical outcomes according to different risk factors. Kaplan–Meier curve and log-rank test for OS. (a) OS stratified by patients with an iBMV above and below the median. (b) OS stratification of patients according to the optimal cut-off value for LMR. (c) OS stratification of patients according to the optimal cut-off value for NLR. (d) OS stratification of patients according to the optimal cut-off value for PLR. (e) OS stratification of patients according to the optimal cut-off value for PNI. (f) OS stratification of patients according to the optimal cut-off value for SII. OS, overall survival; iBMV, initial brain metastasis velocity; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; PNI, prognostic nutritional index; SII, systemic immune-inflammation index; HR, hazard ratio; CI, confidence interval.
Fig. 3
Fig. 3
A nomogram and its validations for MBMs. (a) Nomogram predicting the OS rates at 1, 2 and 3 years for patients with MBMs. The nomogram summed the points identified on the scale for each variable. The total points projected on the bottom scales indicate the probabilities of OS rates at 1, 2 and 3 years. (b) Calibration of the nomogram for predicting 1-year OS rate. (c) Calibration of the nomogram for predicting 2-year OS rate. (d) Calibration of the nomogram for predicting 3-year OS rate. (e) The nomogram’s ROC curves and AUC values for predicting 1-, 2-, and 3-year OS rates. MBMs, malignant melanoma brain metastases; OS, overall survival; iBMV, initial brain metastasis velocity; KPS Karnofsky performance status, Serum LDH, serum lactate dehydrogenase; Serum Alb, serum albumin; SII, systemic immune-inflammation index; ROC, Receiver operating characteristic; AUC, Area under the curve; CI, confidence interval.
Fig. 4
Fig. 4
Comparison of AUC values from 1–3 years for two prognostic scoring models. AUC, Area under the curve; GPA, Graded Prognostic Assessment.
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