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. 2018 Jul;19(4):e373-e379.
doi: 10.1016/j.cllc.2018.01.007. Epub 2018 Mar 9.

Non-small-cell Lung Cancer With Brain Metastasis at Presentation

Saiama N Waqar  1 , Pamela P Samson  2 , Cliff G Robinson  2 , Jeffrey Bradley  2 , Siddhartha Devarakonda  1 , Lingling Du  1 , Ramaswamy Govindan  1 , Feng Gao  3 , Varun Puri  4 , Daniel Morgensztern  5
Affiliations

Non-small-cell Lung Cancer With Brain Metastasis at Presentation

Saiama N Waqar et al. Clin Lung Cancer. 2018 Jul.

Abstract

Background: Data on the prevalence of brain metastases at presentation in patients with non-small-cell lung cancer (NSCLC) are limited. We queried the National Cancer Data Base to determine prevalence, clinical risk factors, and outcomes of patients with NSCLC presenting with brain metastases.

Patients and methods: Patients with NSCLC diagnosed between 2010 and 2012 were identified using the National Cancer Data Base. The risk of brain metastases for individual variables was summarized by odds ratios and calculated using logistic regression analysis. The Kaplan-Meier product limit method was used to calculate the median and 1-, 2-, and 3-year overall survival (OS).

Results: Brain metastases were observed in 47,546 (10.4%) of the 457,481 patients with NSCLC overall. The prevalence of brain metastases was much higher (26%) in patients with stage IV disease at presentation. On multivariate analysis, younger age, adenocarcinoma or large cell histology, tumor size > 3 cm, tumor grade ≥ II, and node-positive disease were associated with brain metastases. The prevalence of brain metastases ranged from as low as 0.57% in patients with only 1 risk factor to as high as 22% in patients with all 5 risk factors. The median and 1-, 2-, and 3-year OS for patients with brain metastases were 6 months and 29.9%, 14.3%, and 8.4%, respectively, with the 3-year OS increasing to 36.2% in those with T1/2 and N0/1 undergoing surgery for the primary site.

Conclusions: In patients with NSCLC, the risk of brain metastases at presentation may be calculated based on 5 clinical variables. Selected patients with brain metastases at presentation may achieve prolonged benefit.

Keywords: Brain metastases; Metastases; NCDB; NSCLC; National Cancer Database.

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Figures

Figure 1.
Figure 1.
Flow diagram showing patients included in the analysis
Figure 2.
Figure 2.
Kaplan Meier curves showing overall survival for patients with stage IV disease according to the presence of brain metastases
Figure 3.
Figure 3.
Kaplan Meier curve for patients with brain metastases, T1–T2, N0–N1 disease and undergoing surgery to the primary site
See this image and copyright information in PMC

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