Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;8(6):374.
doi: 10.21037/atm.2020.02.72.

Risk factors of brain metastases as initial failure in completely resected stage IIIA(N2) non-small cell lung cancer

Qin Zhang  1   2 , Xu-Wei Cai  1   2 , Wen Feng  1   2 , Wen Yu  1   2 , Xiao-Long Fu  1   2
Affiliations

Risk factors of brain metastases as initial failure in completely resected stage IIIA(N2) non-small cell lung cancer

Qin Zhang et al. Ann Transl Med. 2020 Mar.

Abstract

Background: This study aimed to identify the risk factors of brain metastases (BM) as the initial site of failure in patients with completely resected stage IIIA (N2) non-small-cell lung cancer (NSCLC).

Methods: From January 2005 and June 2012, the clinical data of 357 patients with completely resected stage IIIA (N2) NSCLC were reviewed in this study. Kaplan-Meier analysis was used to identify the incidence of BM as the initial site of failure and survival. To assess the risk factors of BM, the log-rank test and Cox regression were used for univariate analysis and multivariate analysis, separately.

Result: Seventy-three (20.4%) patients developed BM; 60 patients had BM as their initial site of failure. The 1-, 3-, and 5-year risk for patients developing BM as the initial site of failure was 9.1%, 27.4% and 35.4%, respectively. Univariate analysis showed adenocarcinoma histology (P=0.000), number of regional LN >4 (P=0.018), multiple N2 stations (P=0.027), multiple region of LN involvement (P=0.010) were significantly associated with an increased risk of developing BM as the initial site of failure. Multivariate analysis showed adenocarcinoma (P=0.001; HR =0.150; 95% CI, 0.047-0.479), multiple regions of LN involvement (P=0.015; HR =2.010; 95% CI, 1.146-3.524) were significantly associated with the high risk of developing BM as the initial site of failure. In patients with adenocarcinoma and multiple regions of LN involvement, the 5-year actuarial risk of BM as the initial failure was 47.6%, respectively.

Conclusions: Adenocarcinoma and multiple regions of LN involvement were independent risk factors for BM as the initial failure in completely resected stage IIIA (N2) NSCLC. Prospective clinical trials are needed to verify the effect of PCI in the highest-risk subset we identified.

Keywords: Brain metastases (BM); adenocarcinoma and multiple region of LN involvement; non-small cell lung cancer (NSCLC); risk factor.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PFS and OS for all the patients. (A) PFS: the median PFS was 19.9 months. (B) OS: the median OS was 43.5 months.
Figure 2
Figure 2
Time to Local recurrence and distant metastasis. (A) local recurrence; (B) distant metastasis.
Figure 3
Figure 3
The cumulative risk of distant metastasis in different sites.
Figure 4
Figure 4
Kaplan-Meier survival curves. (A) the OS in patients with BM or without BM; (B) the OS in patients with BM or without BM as the initial site of failure. BM, brain metastases.
Figure 5
Figure 5
The risk for patients developing BM as the initial site of failure. BM, brain metastases.
Figure 6
Figure 6
The differences among the groups with both, one and none of the two risk factors.
See this image and copyright information in PMC

References

    1. Morgensztern D, Ng SH, Gao F, et al. Trends in stage distribution for patients with non-small cell lung cancer: a National Cancer Database survey. J Thorac Oncol 2010;5:29-33. 10.1097/JTO.0b013e3181c5920c - DOI - PubMed
    1. Shin DY, Na II, Kim CH, et al. EGFR mutation and brain metastasis in pulmonary adenocarcinomas. J Thorac Oncol 2014;9:195-9. 10.1097/JTO.0000000000000069 - DOI - PubMed
    1. Hsiao SH, Chung CL, Chou YT, et al. Identification of subgroup patients with stage IIIB/IV non-small cell lung cancer at higher risk for brain metastases. Lung Cancer 2013;82:319-23. 10.1016/j.lungcan.2013.08.004 - DOI - PubMed
    1. Ding X, Dai H, Hui Z, et al. Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer. Radiat Oncol 2012;7:119. 10.1186/1748-717X-7-119 - DOI - PMC - PubMed
    1. Petrović M, Ilic N, Loncarevic O, et al. Risk factors for brain metastases in surgically staged IIIA non-small cell lung cancer patients treated with surgery, radiotherapy and chemotherapy. Vojnosanit Pregl 2011;68:643-9. 10.2298/VSP1108643P - DOI - PubMed