| ObjectiveBrain metastases(BM)have a poor prognosis and a high mortality rate.Brain metastases from lung cancer are common.Treatments including surgery,radiotherapy,chemotherapy and comprehensive treatment effects are still unsatisfactory.Molecular targeted therapy is good,but it is only suitable for some patients and prone to drug resistance.There are many reports of the prognostic factors of BM,but most of them are for the treatment of BM(both patients and non-operative patients)or non-surgical treatments,and there are few reports of the prognostic factors of the patients with surgical patients.The benefits of the survival of patients with lung cancer in the operation of brain metastable patients can affect the effect of surgical treatment,and further research is needed.In this study,the patient’s medical records and follow-up data of the patients with lung cancer were studied,and the survival and prognostic factors were analyzed,the surgical adaption was discussed,and the prognostic factors of the patients with the surgical effects of the brain metastasization of lung cancer were found,and the reference was provided for surgical treatment.MethodsThe clinical data of lung cancer with brain metastases patients who underwent surgical treatment at the Neurosurgery Department of the Cancer Hospital of the Chinese Academy of Medical Sciences from January 1,2016 to November 30,2018 were collected and analyzed retrospectively.Through the treatment of medical records,outpatient,telephone and other ways,the treatment plan and the survival state of the patients are collected,and all the data are summarized and the corresponding database is established.Using the Kaplan-Meier method for survival analysis,the analysis of single factors was carried out using the Log-Rank method,and the cox method was used to analyze multifactor.Related factors for prognostic analysis include gender,age,smoking history,location of intracranial metastases,number of intracranial metastases,range of surgical resection,KPS,extracranial tumor progression,Lung-mol GPA score,pathology of brain metastases,postoperative targeted therapy,postoperative radiotherapy,postoperative chemotherapy,etc.Using spss23.0 software for statistical analysis of various data,p <0.05 was considered statistically significant.Results 1.Clinical dataA total of 83 complete cases were collected,including 41 males and 42 females.The age of the patient were between 36 y and 84 y.An average age is 58 y and median age is 59 y.There were 35 patients over 60 y,and 48 were aged 60 y and below;There were 35 cases of smoking and 48 cases of non-smoking.55 cases were metastasis above tentorium cerebelli and 11 cases were under tentorium cerebelli.The rest 17 were cases were metastasis hole brain.There were 60 cases with 1 or 2 intracranial metastases and 23 cases with more than 2 intracranial metastases;13 cases had extracranial metastasis,and 70 cases had no extracranial metastasis.Of the 83 patients,only 6 had no significant neurological symptoms before surgery.Others had varying degrees of neurological symptoms,including headache(41 cases),vomiting(11 cases),verbal discomfort(7 cases),limb weakness or mobility disorders(28 cases),balance disorders(12 cases),sensory disturbances(7 cases),visual impairments(7 cases)and other symptoms.KPS score results: KPS scores were range from 40 to 100 points,11 cases with KPS <70,and 72 cases with KPS ≥70.Pathology(including molecular pathology)of brain metastases in patients: 9 cases of small cell carcinoma and 74 cases of non-small cell carcinoma.In the 74 cases,there are 69 cases were adenocarcinoma,and 3 cases were squamous cell carcinoma,and 2 cases were adenosquamous carcinoma.A total of 55 people were tested for lung cancer driver genes,and 47 of them were positive,including 32 EGFR genes,4 ALK genes,2 HER2 genes,5 KRAS genes,and 4 unknown;8 people were negative.Twenty-eight people were not genetically tested.22 cases with Lung-mol GPA score <3,and 61 cases with Lung-mol GPA score ≥3.2.Outcome of treatment and survivalIn 83 cases,only 4 patients had no significant improvement in clinical symptoms,and the other patients had different degrees of remission.The remission rate was 95%.47 patients survived and the remaining 36 patients died.The median overall survival(OS)of 83 patients was 27.0 months,of which the longest survival time was 48.4 months and the shortest survival time was 3.3 months.Among them,41 were male patients,with a median OS of 22.8 months,and 42 were female patients,with a median OS of 28.8 months;The median OS of 48 patients with ages ≤ 60 y was 27.0 months,and 35 patients with ages > 60 y OS is 27.6 months.The one-year and two-year cumulative survival rates of 83 patients were 75.3% and 55.3%,respectively.The patients were divided into a surgery-only treatment group and surgery combined with other adjuvant treatment groups.There were 68 cases with adjuvant treatments and only symptomatic supportive treatment was performed after surgery.There were 15 patients without other adjuvant treatments.The results showed that surgery combined with other adjuvant treatment groups(including radiotherapy,chemotherapy,and targeted therapy)compared with the surgeryonly group,whether the median OS(27.7 months vs 15.7 months,p = 0.003),or 1-year survival rate(80.4% vs 51.3%,p = 0.003)or 2-year survival rate(63.7% vs 22.0%,p = 0.001)were significantly higher than those of the surgery-only group,and the differences were statistically significant.3.Analysis of prognostic factorsLog-Rank univariate analysis showed that women(median OS 28.8 months vs.median OS 22.8 months,p = 0.031)and no history of smoking(27.6 months vs 18.1 months,p = 0.004),Lung-mol GPA score ≥ 3 points(27.7 months vs 15.7 months,p = 0.004),pathological metastases were non-small cells(26.6 months vs 16.6 months,p = 0.001),targeted therapy(median OS > 27.7 months vs 21.9 months p <0.001)are good prognostic factor.And age(27.0 months vs 27.6 months,p = 0.618);metastasis location(27.0 months vs 26.4 months,p = 0.764);number(27.0 months vs 26.4 months,p = 0.416);KPS(22.8 months vs 27.0 months,p = 0.062),without extracranial metastasis(22.8 months vs OS 27.0 months,p = 0.998);postoperative radiotherapy(28.8 months vs 23.0 months,p = 0.256),and postoperative chemotherapy(26.4 months vs 27.6 months,p = 0.792).There was no significant difference in these factors.The results of multivariate analysis showed that the smoking history,targeted therapy,radiotherapy were independent prognostic factors affecting the survival time of patients,with p values of 0.003,<0.001,and 0.028,respectively.ConclusionPatients with BM of lung cancer can benefit from tumor resection.In this study,the cumulative survival rate of patients in 2 years was 55.3%,and the longest survival time was 48.4 months.Female,non-smoker,and non-small cell lung cancer patients with BM surgery can achieve better treatment results.Postoperative combined with other adjuvant treatments can significantly prolong the survival of patients.Both postoperative targeted therapy and radiotherapy can significantly prolong the survival time of patients.It is strongly recommended that patients undergo genetic testing to find molecular targets for targeted therapy.Active brain radiation therapy is recommended after brain transfer surgery.Symptoms of increased intracranial pressure before surgery may affect KPS.Lung-mol GPA are more suitable for prognosis assessment of lung cancer BM than KPS and can be used clinically to predict patient survival. |
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