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. 2020 Jan-Dec;2(1):vdaa041.
doi: 10.1093/noajnl/vdaa041. Epub 2020 Apr 24.

Epidemiology of synchronous brain metastases

Raj Singh  1 , Kelsey C Stoltzfus  2   3 , Hanbo Chen  4 , Alexander V Louie  5 , Eric J Lehrer  6 , Samantha R Horn  2   3 , Joshua D Palmer  7 , Daniel M Trifiletti  8 , Paul D Brown  9 , Nicholas G Zaorsky  2   3
Affiliations

Epidemiology of synchronous brain metastases

Raj Singh et al. Neurooncol Adv. 2020 Jan-Dec.

Abstract

Background: The objectives of this study were to characterize (1) epidemiology of brain metastases at the time of primary cancer diagnosis, (2) incidence and trends of synchronous brain metastases from 2010 to 2015, and (3) overall survival (OS) of patients with synchronous brain metastases.

Methods: A total of 42 047 patients with synchronous brain metastases from 2010 to 2015 were identified from the Surveillance, Epidemiology, and End Results database. Descriptive analysis was utilized to analyze demographics and incidence. The Kaplan-Meier method and a Cox proportional hazards model were utilized to evaluate potential prognostic factors for OS.

Results: The majority of patients were diagnosed from age older than 50 (91.9%). Common primary sites included lung (80%), melanoma (3.8%), breast (3.7%), and kidney/renal pelvis (3.0%). Among pediatric patients, common primaries included kidney/renal pelvis and melanomas. The incidence was roughly 7.3 persons/100 000. Synchronous brain metastases were associated with significantly poorer OS compared to extracranial metastases alone (hazard ratio [HR] =1.56; 95% CI: 1.54-1.58; P < .001). Among patients with brain metastases, male gender (HR = 1.60 vs 1.52), age older than 65 years (HR = 1.60 vs 1.46), synchronous liver, bone, or lung metastases (HR = 1.61 vs 1.49), and earlier year of diagnosis (HR = 0.98 for each year following 2010) were associated with significantly poorer OS.

Conclusions: The vast majority of brain metastases are from lung primaries. Synchronous brain metastases are associated with poorer OS compared to extracranial metastases alone.

Keywords: brain metastases; cancer; epidemiology; incidence; prognosis.

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Figures

Figure 1.
Figure 1.
Incidence of brain metastases among males and females, by age, from SEER 2010 to 2015. (A) Absolute incidence among males by age shows lung as the most common histology. (B) Relative incidence among males by age shows kidney/renal pelvis and melanoma as common histology among younger patients and lung among older patients. (C) Absolute incidence among females by age shows lung as the most common histology. (D) Relative incidence among females by age shows kidney/renal pelvis and melanoma as common histology among younger patients and lung among older patients.
Figure 2.
Figure 2.
Incidence of brain metastases by primary site. (A) Incidence by the primary site shows a stable incidence over time. (B) The total incidence per year shows a stable incidence over time.
Figure 3.
Figure 3.
Forest plots showing poorer overall survival (OS) among patients with brain metastases compared to extracranial metastases alone by the primary site.
See this image and copyright information in PMC

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