Risk Factor Analysis And Efficacy Of Different Therapies For Preventing Brain Metastasis From Stage ? Non-small Cell Lung Cancer After Complete Resection

Objective The patients with non-small cell lung cancer(NSCLC)are still at risk of brain metastasisi(BM)after surgical treatment.The study aim to investigate the clinical characteristics and the risk factors for postoperative brain metastasis in patients with stage ? postoperative NSCLC patients.More importantly,to compare and analyze the difference of intracranial disease-free survival,extracranial disease-free survival and overall survival for stage ? NSCLC patients after complete resection,which is is influenced by the treatments of insufficient intervention,adjuvant chemotherapy,epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)and adjuvant chemotherapy combined with EGFR-TKIs.Methods The clinical and prognostic data of 179 patients with NSCLC in our department of oncology from May 2010 to July 2014 were retrrospectively and analyzed.The occrrence of postoperative brain metastasis in NSCLC patients with different characteristics were boserved.Cox model was rsed to investigare the risk factors for postopertative brain metasitasis in patients with NSCLC.138 lung adenocarcinoma patients of the study were divided into 4 groups:insufficient intervention,adjuvant chemotherapy,EGFR-TKIs and adjuvant chemotherapy combined with EGFR-TKIs.Then,the intracranial disease-free survival,extracranial disease-free survival and overall survival was observed in each group respectively.Results Univariate analysis shoued that the rates of postoperative brain metasitasis in NSCLC patients with different histological types,number of metastatic mediastinal lymph nodes were statistically significant(P<0.05).Cox regression showed that adenocarcinoma(P=0.043,HR=7.846,95%CI:1.068~57.632),number of metastatic mediastinal lymph nodes(>6)(P=0.012,HR=6.304,95%CI:1.193~4.182)were risk factors for postoperative brain metastasis in patients with NSCLC.For the stage ? adenocarcinoma patients,compared with recieving insufficient intervention,patients with EGFR-TKIs treatment showed statistical difference in extracranial disease-free survival(50% VS.28.6%,P=0.030)and overall survival(77.3% VS.62.3%,P=0.034).The group of adjuvant chemotherapy combined with EGFR-TKIs also showed its benefit in overall survival(75.0% VS.62.3%,P=0.040).In subgroup analysis,EGFR-TKIs group showed lower incidences of BM than insufficient intervention group(87.5% VS.60%,P=0.047)for adenocarcinoma patients harboring EGFR sensitive mutation.Conclusion The stage ? NSCLC postoperative patients with pulmonary adenocarcinoma,metastatic mediastinal lymph nodes(>6)are more likely to develop brain metastasis.For adenocarcinoma patients,EGFR-TKIs therapy significantly prolong extracranial disease-free survival and overall survival,and it decrease BM risk in patients harboring sensitive EGFR mutations.