Prognostic factors and outcome of surgically treated patients with brain metastases of non-small cell lung cancer

Abstract

Background: Brain metastases (BM) are a common consequence of lung cancer and surgery is effective; however, the factors affecting survival after surgery are unclear. The aim of this study was to identify the outcomes and prognoses of post-metastasectomy patients with BM from non-small cell lung cancer (NSCLC) at a single institution over a 15-year period.

Methods: NSCLC patients who had undergone BM surgery were retrospectively identified. Survival was analyzed using the Kaplan-Meier curve, and univariate and multivariate factors associated with survival were identified using the Cox proportional hazards model.

Results: The median overall survival was 9.8 months, 18 (14.8%) patients survived > 24 months, and 6 (4.9%) > 36 months. The one and two-year survival rates were 41% and 18.6%, respectively. Univariate analysis revealed that recursive partitioning analysis (RPA) classification, Karnofsky Performance Scale (KPS) scores, BM number, extracranial metastasis status, different lesion locations, resection extent, postoperative treatment, and salvage therapy after recurrence significantly influenced patient survival. The different treatment modalities for primary lesions also affected postoperative survival. KPS ≥ 70, RPA class I/II, and postoperative chemotherapy were independent factors that decreased the risk of death from BM. Interestingly, the initial onset of intracranial lesions could increase the risk of death from BM.

Conclusion: A KPS score ≥ 70, RPA class I/II, and postoperative chemotherapy could benefit post-metastasectomy patients with BM from NSCLC. Conversely, the initial onset of intracranial lesions is an unfavorable factor that increases the risk of death. These findings support the use of personalized therapy for patients with BM from NSCLC.

Keywords: Brain metastases; non-small cell lung cancer (NSCLC); prognostic factor; recursive partitioning analysis (RPA).

Figure 1

Kaplan–Meier analysis of parameters significantly associated with overall survival (OS, calculated from the first craniotomy for brain metastases). (a) Patients in different recursive partitioning analysis (RPA) classes; (b) Karnofsky Performance Scale (KPS) score; (c) number of intracranial lesions; (d) extracranial metastases; (e) location of lesions; (f) treatment modality after surgery; (g) extent of resection; and (h) postoperative treatment. CI, confidence interval.

Figure 2

Multivariate analysis of prognostic factors associated with overall survival. CI, confidence interval; HR, hazard ratio; KPS, Karnofsky Performance Scale; RPA, recursive partitioning analysis.