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Multicenter Study
. 2025 Oct;175(1):367-377.
doi: 10.1007/s11060-025-05139-1. Epub 2025 Jul 21.

Prevalence, therapeutic approaches, and survival rates of brain metastases in non-small cell lung cancer: a multi-institutional claims-based study from 2014 to 2024

Megan Parker  1 , Kelly Jiang  1 , Anita Kalluri  1 , Alyssa G Arbuiso  1 , Austin Carmichael  1 , Joshua Materi  1 , Tej D Azad  1 , Jinny Suk Ha  2 , Solmaz Sahebjam  3 , David O Kamson  4 , Kristin J Redmond  5 , Lawrence R Kleinberg  5 , Xiaobu Ye  1 , Chetan Bettegowda  1 , Jordina Rincon-Torroella  6
Affiliations
Multicenter Study

Prevalence, therapeutic approaches, and survival rates of brain metastases in non-small cell lung cancer: a multi-institutional claims-based study from 2014 to 2024

Megan Parker et al. J Neurooncol. 2025 Oct.

Abstract

Purpose: Brain metastases (BM) cause substantial morbidity and mortality in patients with non-small cell lung cancer (NSCLC). Updated epidemiological studies are crucial to guide screening and treatment strategies. We investigated the prevalence, timing, and outcomes of BM in patients diagnosed with NSCLC utilizing the TrinetX Oncology database.

Methods: Data from patients with histologically confirmed NSCLC were extracted from the TrinetX Oncology database. Precocious, synchronous, and metachronous BM were defined as BM diagnosed before, within 2 months, and after 2 months of the NSCLC diagnosis, respectively. Clinical variables were compared between patients with and without BM using Chi-squared and t-tests. Kaplan-Meier and Cox regression analyses were used to evaluate overall survival (OS), after propensity-score matching for age at diagnosis of NSCLC, sex, stage at diagnosis, extracranial metastases, and cancer-directed therapy.

Results: Among 25,714 patients with NSCLC, 18.9% had BM (3.1% precocious, 6.5% synchronous, and 9.3% metachronous). The median time to BM was 7.7 months in patients with initial stage IV NSCLC. Patients with BM received significantly higher rates of cancer-directed therapies compared to those without BM. Patients with BM (with or without extracranial metastases) had reduced OS compared to patients with extracranial metastases only (HR[95%CI] = 1.2[1.1-1.3]). Synchronous BM were associated with lower OS than metachronous BM after the diagnosis of NSCLC (HR[95%CI] = 1.8[1.6-2.0]), but not after BM diagnosis.

Conclusion: BM impact outcomes of patients with NSCLC causing significant morbidity and mortality. Our findings highlight the importance of early detection and targeted interventions in NSCLC patients at risk of BM.

Keywords: Brain metastases; Non-small cell lung cancer; Oncology; Retrospective cohort; TriNetX.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval was granted by the Institutional Review Board and Johns Hopkins University. Consent to participate was waived by the Institutional Review Board and Johns Hopkins University. Consent for publication: Consent to publish was not required for this study. Competing interests: C.B.: is a consultant for Depuy-Synthes, Bionaut Labs, Galectin Therapeutics, Haystack Oncology, and Privo Technologies. C.B. is a co-founder of OrisDx and Belay Diagnostics. K.J.R.: Research funding from Accuray, Canon, Elekta AB, icotec; travel expenses from Elekta AB, Accuray, icotec, Brainlab; patent under development with Canon for radiogenomics; data safety monitoring board for BioMimetix. Previous presentations: This study was presented as a poster presentation at the Congress of Neurological Surgeons 2024 Annual Meeting in Houston, Texas.

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