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. 2018 Jan;41(1):36-40.
doi: 10.1097/COC.0000000000000230.

Brain Metastases at Presentation in Patients With Non-Small Cell Lung Cancer

Saiama N Waqar  1 , Sadaf H Waqar  1 , Kathryn Trinkaus  2 , Carlos A Gadea  3 , Cliff G Robinson  4 , Jeffrey Bradley  4 , Mark A Watson  5 , Varun Puri  6 , Ramaswamy Govindan  1 , Daniel Morgensztern  1
Affiliations

Brain Metastases at Presentation in Patients With Non-Small Cell Lung Cancer

Saiama N Waqar et al. Am J Clin Oncol. 2018 Jan.

Abstract

Objective: We used brain radiotherapy as a surrogate for the presence of brain metastases in patients with non-small cell lung cancer (NSCLC) to determine the prevalence of brain metastases using the Surveillance Epidemiology and End Results database.

Methods: Patients with NSCLC diagnosed between 1988 and 1997 were subdivided according to brain radiotherapy status at presentation into: "none" or "radiation therapy indicated." We calculated the frequency of brain radiotherapy use in all patients. Odds ratios (ORs) for the indication of brain radiotherapy were calculated for individual prespecified covariates of interest. All statistical tests were 2-sided and P<0.05 were considered significant.

Results: At presentation, brain radiotherapy was indicated in 10,963 (8.3%) of the 131,456 patients diagnosed with NSCLC between 1988 and 1997. On multivariable analysis the following were significantly associated with brain radiotherapy use: age (OR, 0.653 per 10 y increase in age; 95% confidence interval [CI]: 0.642, 0.665); female sex (OR, 1.05; 95% CI: 1.01, 1.10]); adenocarcinoma histology (HR, 1.67; 95% CI: 1.58, 1.76) or large cell or other histology (OR, 1.67; 95% CI: 1.57, 1.77); tumor size>3 cm (3.1 to 5 cm OR, 1.22; 95% CI: 1.14, 1.30 and >5 cm OR, 1.25; 95% CI: 1.17, 1.33); tumor grade >II (grade III OR, 1.82; 95% CI: 1.69, 1.95 and grade IV OR, 1.91; 95% CI: 1.73, 2.11); and nodal involvement N1 (OR, 1.33; 95% CI: 1.20, 1.47), N2 (OR, 2.24; 95% CI: 2.10, 2.40), and N3 (OR, 2.39; 95% CI: 2.19, 2.60).

Conclusions: Brain radiotherapy is indicated in over 8% of patients with NSCLC at presentation. We demonstrated that the risk of brain metastasis at presentation may be stratified with the use of 6 clinical factors.

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Figures

Figure 1
Figure 1
Consort diagram showing patients included in our study
Figure 2
Figure 2
Color intensity scale showing the frequency of use of brain radiotherapy according to combination of clinical risk factors
Figure 3
Figure 3
Forest plot showing odds of brain radiotherapy in relation to clinical variables
Figure 4
Figure 4
ROC curve illustrating performance of the multivariable model to predict brain radiotherapy use
See this image and copyright information in PMC

Comment in

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