{"title":"非小细胞肺癌所致I型脑膜轻脑膜转移的危险因素及脑转移治疗对其发展的影响","authors":"Toshihiko Iuchi, Masato Shingyoji, Satoko Mizuno, Hironori Ashinuma, Yuzo Hasegawa, Taiki Setoguchi, Junji Hosono, Tsukasa Sakaida","doi":"10.1093/nop/npae118","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Preventing Type I leptomeningeal metastasis (LM) is critical when treating brain metastases (BMs). The aim of this study was to extract risk factors for Type I LM and to clarify the optimal treatment for BMs from the perspective of Type I LM prevention.</p><p><strong>Methods: </strong>The clinical course of consecutive cases of BMs derived from non-small cell lung cancer (NSCLC) treated at our hospital was retrospectively evaluated. The relationship between clinicopathological factors, including molecular background, and Type I LM development was verified. In addition, the difference in the time to Type I LM because of treatment for BMs was evaluated to clarify the effectiveness of each treatment in preventing Type I LM.</p><p><strong>Results: </strong>Of 784 patients with BMs, 44 exhibited Type I LM at the onset of BMs. Poor performance status (<i>P</i> < .0001) and mutated epidermal growth factor receptor (<i>EGFR</i>) gene (<i>P</i> = .004) were significant risk factors for Type I LM. Among the 740 patients without LMC at diagnosis, 85 developed Type I LM. Younger age (<i>P</i> = .011) and mutated <i>EGFR</i> (<i>P</i> < .0001) were risk factors for developing LMC after BMs. Osimertinib reduced the incidence of Type I LM (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97) in <i>EGFR</i>-mutated cases. Immune checkpoint inhibitors (ICIs) showed a tendency to prolong the time to Type I LM (HR: 0.15; 95% CI: 0.02-1.11) in <i>EGFR</i>-wild-type cases.</p><p><strong>Conclusions: </strong>Patients with <i>EGFR</i>-mutated NSCLC are prone to developing Type I LM. Osimertinib for <i>EGFR</i>-mutated cases and ICIs are expected to prevent Type I LM after the diagnosis of BMs.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"448-457"},"PeriodicalIF":2.5000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137222/pdf/","citationCount":"0","resultStr":"{\"title\":\"Risk factors for type I leptomeningeal metastasis derived from non-small cell lung cancer and the impact of treatment for brain metastases on its development.\",\"authors\":\"Toshihiko Iuchi, Masato Shingyoji, Satoko Mizuno, Hironori Ashinuma, Yuzo Hasegawa, Taiki Setoguchi, Junji Hosono, Tsukasa Sakaida\",\"doi\":\"10.1093/nop/npae118\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Preventing Type I leptomeningeal metastasis (LM) is critical when treating brain metastases (BMs). The aim of this study was to extract risk factors for Type I LM and to clarify the optimal treatment for BMs from the perspective of Type I LM prevention.</p><p><strong>Methods: </strong>The clinical course of consecutive cases of BMs derived from non-small cell lung cancer (NSCLC) treated at our hospital was retrospectively evaluated. The relationship between clinicopathological factors, including molecular background, and Type I LM development was verified. In addition, the difference in the time to Type I LM because of treatment for BMs was evaluated to clarify the effectiveness of each treatment in preventing Type I LM.</p><p><strong>Results: </strong>Of 784 patients with BMs, 44 exhibited Type I LM at the onset of BMs. Poor performance status (<i>P</i> < .0001) and mutated epidermal growth factor receptor (<i>EGFR</i>) gene (<i>P</i> = .004) were significant risk factors for Type I LM. Among the 740 patients without LMC at diagnosis, 85 developed Type I LM. Younger age (<i>P</i> = .011) and mutated <i>EGFR</i> (<i>P</i> < .0001) were risk factors for developing LMC after BMs. Osimertinib reduced the incidence of Type I LM (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97) in <i>EGFR</i>-mutated cases. Immune checkpoint inhibitors (ICIs) showed a tendency to prolong the time to Type I LM (HR: 0.15; 95% CI: 0.02-1.11) in <i>EGFR</i>-wild-type cases.</p><p><strong>Conclusions: </strong>Patients with <i>EGFR</i>-mutated NSCLC are prone to developing Type I LM. Osimertinib for <i>EGFR</i>-mutated cases and ICIs are expected to prevent Type I LM after the diagnosis of BMs.</p>\",\"PeriodicalId\":19234,\"journal\":{\"name\":\"Neuro-oncology practice\",\"volume\":\"12 3\",\"pages\":\"448-457\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-12-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137222/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuro-oncology practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/nop/npae118\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuro-oncology practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/nop/npae118","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Risk factors for type I leptomeningeal metastasis derived from non-small cell lung cancer and the impact of treatment for brain metastases on its development.
Background: Preventing Type I leptomeningeal metastasis (LM) is critical when treating brain metastases (BMs). The aim of this study was to extract risk factors for Type I LM and to clarify the optimal treatment for BMs from the perspective of Type I LM prevention.
Methods: The clinical course of consecutive cases of BMs derived from non-small cell lung cancer (NSCLC) treated at our hospital was retrospectively evaluated. The relationship between clinicopathological factors, including molecular background, and Type I LM development was verified. In addition, the difference in the time to Type I LM because of treatment for BMs was evaluated to clarify the effectiveness of each treatment in preventing Type I LM.
Results: Of 784 patients with BMs, 44 exhibited Type I LM at the onset of BMs. Poor performance status (P < .0001) and mutated epidermal growth factor receptor (EGFR) gene (P = .004) were significant risk factors for Type I LM. Among the 740 patients without LMC at diagnosis, 85 developed Type I LM. Younger age (P = .011) and mutated EGFR (P < .0001) were risk factors for developing LMC after BMs. Osimertinib reduced the incidence of Type I LM (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97) in EGFR-mutated cases. Immune checkpoint inhibitors (ICIs) showed a tendency to prolong the time to Type I LM (HR: 0.15; 95% CI: 0.02-1.11) in EGFR-wild-type cases.
Conclusions: Patients with EGFR-mutated NSCLC are prone to developing Type I LM. Osimertinib for EGFR-mutated cases and ICIs are expected to prevent Type I LM after the diagnosis of BMs.
期刊介绍：
Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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