Prevalence and risk factors of brain metastases in patients with newly diagnosed advanced non-small-cell lung cancer

Abstract

Micro-abstract

Brain metastases are a frequent finding in patients with advanced non-small cell lung cancer (NSCLC). The characteristics of 118 patients with synchronous brain metastases (BM) out of a cohort of 678 individuals with advanced NSCLC (17%) are reported, with synchronous BM having a negative impact on survival. Prognostic factors for survival of the patients with and without BM are presented.

Background

Brain metastases occur frequently in patients with newly diagnosed non-small cell lung cancer. We aim to describe the characteristics, treatment and course of disease in patients with synchronous BM in an advanced NSCLC cohort, and to comparatively analyze prognostic factors for patients with and without BM.

Patients and methods

Of 678 consecutive unselected patients with stage IV NSCLC, 118 presented with synchronous BM (17%; 95% confidence interval [CI]: 15–20%). The patient characteristics, prognostic factors, therapeutic approach and use of specific therapeutic measures including systemic treatment were analyzed.

Results

BM were found more frequently in younger patients, females, non-smokers and those with a lower thoracic stage. 29% of patients with BM exhibited neurologic symptoms. Patients with BM showed worse overall survival (median survival 8.0 vs 9.7 months; HR 1.24 [1.05–1.54]; p=0.045). In multivariable analysis poor performance status at diagnosis showed the strongest negative association with survival.

Conclusion

Synchronous BM are frequent among patients with NSCLC even in early thoracic stages and negatively impact survival. Based on the findings presented in this paper, a therapy algorithm for treating BM is proposed, with systemic therapy being one valuable option.