Analysis of clinical characteristics and prognostic factors in patients with non-small cell lung cancer with brain metastasis
YANG Siqi1 YAO Yi1,2 SONG Qibin1,2▲
1.Cancer Center, Renmin Hospital of Wuhan University, Hubei Province, Wuhan 430060, China;
2.Hubei Provincial Research Center for Precision Medicine of Cancer, Hubei Province, Wuhan 430020, China
Abstract：Objective To explore the clinical characteristics and prognostic factors in patients of non-small cell lung cancer with brain metastasis. Methods A total of 9411 patients with organ metastasis of non-small cell lung cancer from January 2000 to January 2005 were collected by SEER*stat software. The clinical characteristics of 4299 patients with brain metastasis and 5112 patients without brain metastasis were compared by chi-square test and binary logistic regression. Kaplan-Meier method was used to analyze the clinical and pathological characteristics that possible influencing factors of brain metastasis. Log-Rank method was used to test the difference of survival rate. Multivariate Cox regression model was used to analyze the independent risk factors that affect the long-term prognosis of non-small cell lung cancer patients with brain metastasis. The Nomogram figure was constructed by R software version 3.4.4 using independent risk factors affecting long-term prognosis, and the predictive value of the model was evaluated by calculating the consistency index (C-index). Results The results of binary logistic regression showed that age (OR=1.284, 95%CI：1.243-1.326, P ＜ 0.001), gender (OR=0.785, 95%CI：0.731-0.843, P ＜ 0.001), pathological type (OR=0.622, 95%CI：0.575-0.673, P ＜ 0.001), N stage (OR=1.094, 95%CI：1.058-1.131, P ＜ 0.001) were independent risk factors for brain metastasis. The results of multivariate Cox regression showed that age (HR=1.25, 95%CI：1.210-1.290, P ＜ 0.001), race (HR=0.865, 95%CI：0.823-0.909, P ＜ 0.001), gender (HR=0.827, 95%CI：0.774-0.884, P ＜ 0.001), histological grade (HR=1.198, 95%CI：1.133-1.267, P ＜ 0.001), pathological type (HR=0.740, 95%CI：0.682-0.803, P ＜ 0.001), Tumor stage (HR=1.078, 95%CI：1.054-1.104, P ＜ 0.001), N stage (HR=1.078, 95%CI：1.044-1.114, P ＜ 0.001), bone metastasis (HR=0.917, 95%CI：0.850-0.989, P < 0.05), liver metastasis (HR=0.742,95%CI：0.673-0.819, P ＜ 0.001) were independent prognostic factors of non-small cell lung cancer patients with brain metastasis. The C-index was calculated as 0.643. Conclusion The incidence of brain metastasis is higher in young women, adenocarcinoma and patients with early N stage. The prognosis of elderly white male patients with high histological grade, squamous cell carcinoma, late Tumor stage and N stage, bone metastasis and liver metastasis is poor. The clinical model has a medium predictive value.
杨思琦1 姚颐1,2 宋启斌1,2▲. 非小细胞肺癌脑转移患者临床特征及预后影响因素分析[J]. 中国医药导报, 2020, 17(32): 4-8,16.
YANG Siqi1 YAO Yi1,2 SONG Qibin1,2▲. Analysis of clinical characteristics and prognostic factors in patients with non-small cell lung cancer with brain metastasis. 中国医药导报, 2020, 17(32): 4-8,16.
[1] 刘宇，张幸平，刘辉，等. 非小细胞肺癌脑转移放射治疗预后因素分析[J].中华肿瘤防治杂志，2014，21（21）：1719-1722.
[2] Mitchell T，Maclaren V. An audit of survival in patients diagnosed with non-small cell lung cancer（NSCLC） and brain metastasis [J]. Lung Cancer，2018，115（22）：S31.
[3] Golding B，Luu A，Jones R，et al. The function and therapeutic targeting of anaplastic lymphoma kinase（ALK） in non-small cell lung cancer（NSCLC）[J]. Mol Cancer，2018， 17（1）：52.
[4] Toffart AC，Duruisseaux M，Brichon PY，et al. Operation and Chemotherapy：Prognostic?魦 Factors for Lung Cancer With?魦 One?魦 Synchronous Metastasis [J]. Ann Thorac Surg，2018，105（3）：957-965.
[5] Aljohani HM，Mohamed A，Furgason JM，et al. Genetic mutations associated with lung cancer metastasis to the brain [J]. Mutagenesis，2018，33（2）：137-145.
[6] Chang WY，Wu YL，Su PL，et al. The impact of EGFR mutations on the incidence and survival of stages Ⅰ to Ⅲ NSCLC patients with subsequent brain metastasis [J]. PLoS One，2018，13（2）：e0192161.
[7] Burdett NL，Karapetis CS. Acanthosis Palmaris：A Rare Paraneoplastic Manifestation of Non-Small-Cell Lung Cancer [J]. J Oncol Prac，2018，14（5）：331-332.
[8] Carlo ED，Savio MCD，Polesel J，et al. Outcomes of ALK positive lung cancer patients treated with crizotinib or second-generation ALK inhibitor：A monoinstitutional experience [J]. Oncotarget，2018，9（20）：15340-15349.
[9] 王卓，张玉宇，张兰广，等.非小细胞肺癌脑转移的治疗进展[J].中国老年学杂志，2016，36（4）：232-236.
[10] Dimitropoulos C，Hillas G，Nikolakopoulou S，et al. Prophylactic cranial irradiation in non-small cell lung cancer patients：Who might be the candidates? [J]. Cancer Manag Res，2011，3（1）：287-294.
[11] Ballard P，Yates J W，Yang Z，et al. Preclinical Comparison of Osimertinib with Other EGFR-TKIs in EGFR-Mutant NSCLC Brain Metastases Models，and Early Evidence of Clinical Brain Metastases Activity [J]. Clin Cancer Res，2016，22（20）：1078-1083.
[12] 杨慧，吴玉芬，黄勇.非小细胞肺癌脑转移的危险因素分析[J].山东医药，2015，10（7）：41-43.
[13] Petrovi■ M, Tomi■ I, Jovanovi■ D. Risk factors for brain metastases after definitive chemoradiation for locally advanced non-small cell lung cancer[J]. Vojnosanit pregl，2009，66（11）：876-880.
[14] Takeo U，Fumi H，Phyo K，et al. 10070：MET-02 Non-small-cell lung cancer with synchronous brain metastasis in the era of molecular targeted drugs：treatment outcome and risk factors [J]. Neuro Oncol Adv，2019，10（9）：139-143.
[15] Go M，Toshio K，Isao O，et al. Second primary cancer in survivors of locally advanced non-small cell lung cancer treated with concurrent chemoradiation followed by surgery [J]. Jpn J Clin Oncol，2018，48（3）：287-290.
[16] Chen H，Wu A，Tao H，et al. Concurrent versus sequential whole brain radiotherapy and TKI in EGFR-mutated NSCLC patients with brain metastasis [J]. Medicine，2018， 97（44）：437-441.
[17] 欧国瑶，张俊杰，林小凤，等.非小细胞肺癌脑转移的治疗研究进展[J].中国临床神经科学，2018，26（2）：222-228.
[18] Bui N，Woodward B，Johnson A，et al. Novel Treatment Strategies for Brain Metastases in Non-small-cell Lung Cancer [J]. Curr Treat Option Oncol，2016，17（5）：25.
[19] Bina T，Kakusa S，Summer A，et al. Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer [J]. J Neuro Oncol，2018，15（4）：3309-3313.
[20] Nonagase Y，Okamoto K，Iwasa T，et al. Afatinib-refractory brain metastases from EGFR-mutant non-small-cell lung cancer successfully controlled with erlotinib：a case report [J]. Anti-Cancer Drug，2016，27（3）：251-253.
[21] Jammal M ，Hilal L，Assi H，et al. Successful treatment of a solitary brain metastasis from small cell lung cancer with whole brain radiotherapy and stereotactic radiosurgery boost：A case report [J]. Precision Radiat Oncol，2018，2（4）：131-134.
[22] 程志远，王俊男，闫枫尚，等.结直肠癌肺转移患者临床特征及预后影响因素分析——基于SEER数据库的回顾性研究[J].中华结直肠疾病电子杂志，2019，8（3）：251-256.
[23] Padma K，Nanaware S，Pande N，et al. Radiation-Induced Neuropsychiatric Manifestations in a Patient with Brain Metastasis：A Diagnostic and Therapeutic Challenges for Consultation-Liaison Psychiatrist [J]. Indian J Palliat Care，2018，24（3）：369-371.
[24] 冯宇，胡兴胜.非小细胞肺癌脑转移治疗的研究进展[J].中国肿瘤临床，2018，45（7）：331-338.
[25] Yiqian W，Xiupeng L，Xiaoqin D，et al. Survival prognostic factors for non-small cell lung cancer patients with brain-only oligometastases [J]. Journal Dalian Med Univer Sity，2018，22（3）：118-123.
[26] Li B，Bao Y，Chen B，et al. Therapy for non-small-cell lung cancer patients with brain metastasis [J].中德临床肿瘤学杂志：英文版，2014，14（10）：483-488.
[27] 刘柯，黄维，王昌平，等.放化疗结合靶向治疗非小细胞肺癌脑转移临床疗效观察[J].智慧健康，2018，4（3）：180-181.
[28] 孙艺媛，丁广成，陈鑫，等.非小细胞肺癌脑转移风险预测的诺模图评分模型应用探究[J].临床肿瘤学杂志，2019，10（10）：13-17.
[29] Doll KM，Rademaker A，Sosa JA. Practical Guide to Surgical Data Sets：Surveillance，Epidemiology，and End Results（SEER）Database [J]. JAMA Surg，2018，153（6）：505-507.
2020, Vol. 17 
京公网安备 11010502046598号