The Survival And Effective Prognostic Factors In Lung Cancer Patients With Brain Metastases Treated With Whole-brain Radiotherapy

Background:To evaluate the survival outcome and explore the risk factors of survival in lung cancer patients with brain metastases who were treated with whole brain radiotherapy(WBRT).Then we explored whether these risk factors can be used to build a predictive model to predict the survival time of lung cancer patients with brain metastases after receiving WBRT.Methods:We historically and prospectively analyzed lung cancer patients with brain metastases who were treated with WBRT between January 2014 and December 2017 in the department of radiation and oncology of the second hospital affiliated Soochow university.Survival time was calculated via the Kaplan-Meier method.To determine the best cutoff value of neutrophil-lymphocyte ratio(NLR)for the survival prognosis of lung cancer patients with brain metastases treated with WBRT,the receiver operating characteristic(ROC)curve analysis was used.Results:In total,179 patients were evaluated.Median overall survival(OS)was 9.9(95%confidence interval[CI]:7.08-12.72)months.Univariate analysis showed that histology(P=0.000),number of brain metastases(P=0.009),local treatment of brain metastases(P=0.019),Karnofsky performance status score(P=0.001),Graded Prognostic Assessment score(P=0.000),hemoglobin level(P=0.002),lymphocyte count(P=0.006),albumin level(P=0.001),and NLR(P=0.000)significantly affected OS.In multivariate analysis,Non-adenocarcinoma histology(P=0.000)and high NLR(P=0.006)were independent risk factors for OS.The optimal NLR cutoff value was 7.0.Each risk factor of histology and NLR was assigned 1 point,and patients were divided into 3 categories based on their total score.Median survival in patients with scores of 0,1,and 2 were 19.6,8.5,and 2.2 months,respectively(P=0.001).Conclusions:This analysis showed that for lung cancer patients with brain metastases who underwent WBRT,non-adenocarcinoma histology and high NLR are independent prognostic factors for survival.A prognostic model comprising histological type and NLR can be used to evaluate survival.