Prognostic Factors Analysis Of Non-small Cell Lung Cancer With Brain Metastases

Objective:There is a high incidence of brain metastases in non-small cell lung cancer,result in treatment failure.The usual outcome of untreated patients is very poor.How to improve living quality and extend the median survival is a hot one for clinical studies.Therefore,this study attempted to analyze the prognostic factors of the non-small cell lung cancer with brain metastases,and evaluate the impact of multi-treatment modalities over survival of these patient,provide help for clinical treatment.Methods and Materials:145 patients who were diagnosed for brain metastasis from Non-small cell lung primary cancer by MRI at the Cancer Hospital affiliated to Fujian Medical University from January 2010 to December 2013 were retrospectively reviewed.A number of potential influencing factors which might affect prognosis were evaluated,including age,gender,pathological type,Karnofsky performance score(KPS),tumor and lymph node staging,internal from diagnosis of lung cancer to the development of BM,symptoms at BM diagnosis,number of BM,region of BM,maximum diameter of BM,peritumoral brain edema,radiation boost following WBRT and the treatments.Survival time was recorded from BM diagnosed to die or final follow-up.Survival rate was calculated by Kaplan-Meier method.Log-rank method was adopted to compare the difference of each inferior group in survival rate.The multi-variate analysis about survival was performed with Cox’S regression proportional model.Statistical significance was defined as P<0.05.Results: 1.There were 145 patients in the research,median survival time(MST)from BM diagnosed was 13.0 months,6-month,1-year and 2-year survival rates were82.8%,52.4%and 25.8%,respectively。The univariate analysis showed KPS, the presence of extracranial metastases,symptoms at BM diagnosis,side of the brain metastases,meningeal metastases and maximum diameter of BM had tendency to statistical differences(P value are 0.009、0.09、0.004、0.044、0.023、0.044,respectively).The multivariate analysis indicated that the presence of extracranial metastases,symptoms at BM diagnosis and meningeal metastases were closely related to the prognosis.2.The MST of the patients receiving WBRT alone,WBRT combined with chemotherapy and WBRT combined with targeted therapy were 7,17,19 months respectively(P=0.003).On subgroup analysis,the MST of the patients with and without radiation boost were 24.0 and 11 months respectively(P=0.014).The MST of the patients with ≥4 cycles of chemotherapy and those with <4 cycles of chemotherapy were 10 and 20 months respectively(P=0.001).The MST of the patients in the upfront RT group compared with the up-front EGFR-TKI group were 21 and 12 months(P=0.264),Intracranial progression-free survival(i PFS)were 17 and 9 months(P=0.284).Conclusions:Based on the results of our study,we confirmed that no extracranial metastasis,no Symptoms at BM diagnosis and meningeal metastases are independent prognostic factors in NSCLC with brain metastases.The patients with KPS>70,absence of extracranial metastases,≥ 4cycles of chemotherapy and combination treatment with EGFR-TKIs have long survival time and they can benefit from multi-treatment.