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. 2012 Jul 30:7:119.
doi: 10.1186/1748-717X-7-119.

Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer

Xiao Ding  1 , Honghai Dai, Zhouguang Hui, Wei Ji, Jun Liang, Jima Lv, Zongmei Zhou, Weibo Yin, Jie He, Luhua Wang
Affiliations

Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer

Xiao Ding et al. Radiat Oncol. .

Abstract

Background: Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset.

Methods: Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan-Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM.

Results: Fifty-three (24.4 %) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86-9.19; P = 0.001) and the ratio of metastatic to examined nodes or lymph node ratio (LNR) ≥ 30 % (RR: 3.33, 95 % CI: 1.79-6.18; P = 0.000) were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %.

Conclusions: In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.

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Figures

Figure 1
Figure 1
Overall survival for the 217 patients.
Figure 2
Figure 2
Disease-free survival (DFS) for the 217 patients.
Figure 3
Figure 3
Time to locoregional recurrence for the 217 patients.
Figure 4
Figure 4
Time to distant metastasis for the 217 patients.
Figure 5
Figure 5
The actuarial risk of developing brain metastases (BM) for the 217 patients.
Figure 6
Figure 6
Comparison of the actuarial risk of developing brain metastases (BM) between squamous cell cancer and non squamous cell cancer.
Figure 7
Figure 7
Comparison of the actuarial risk of developing brain metastases (BM) between lymph node ratio (LNR) ≥ 30 % and LNR < 30 %.
Figure 8
Figure 8
Comparison of the actuarial risk of developing brain metastases (BM) among patients with two, one, and none of the two risk factors, non-squamous cell cancer histology and lymph node ratio (LNR) ≥ 30 %.
See this image and copyright information in PMC

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