Abstract
The incidence of brain metastases (BM) varies in patients with non-small cell lung cancer (NSCLC), calls into question the value of prophylactic cranial irradiation (PCI). It is possible that clinicopathologic characteristics are associated with the development of BM, but these have yet to be identified in detail. Thus, we conducted the present meta-analysis on risk factors for BM and the value of PCI in patients with NSCLC. Eligible data were extracted and the risk factors for BM and the value of PCI in patients with NSCLC were analyzed by calculating the pooled odds ratio (OR). Heterogeneity was detected using Q and I-squared statistics, and publication bias was tested by funnel plots and Egger's test. Six randomized controlled trials with a focus on the value of PCI and 13 eligible studies with a focus on risk factors for BM were included. PCI significantly reduced the incidence of BM in patients with NSCLC (p=0.000, pooled OR=0.34, 95% confidence interval = 0.37-0.59). Compared with non-squamous cell carcinoma, squamous cell carcinoma was associated with a low incidence of BM in patients with NSCLC (p=0.000, pooled OR=0.47, 95% confidence interval =0.34- 0.65). The funnel plot and Egger's test suggested that there was no publication bias in the current meta-analysis. This meta-analysis provides statistical evidence that compared with non-squamous cell carcinoma, squamous cell carcinoma can be used as a predictor for BM in patients with NSCLC, and PCI might reduce the incidence of BM in patients with NSCLC, but does not provide a survival benefit.
Highlights
Lung cancer is the leading cause of cancer deaths worldwide
Characteristics of the Included Studies According to the above search strategy, inclusion and exclusion criteria, we selected 13 eligible studies involving risk factors for brain metastases (BM); a total of 3182 patients were enrolled in these studies
prophylactic cranial irradiation (PCI) Influence on the Incidence of BM in non-small cell lung cancer (NSCLC) Among six randomized controlled trials (RCTs) involving the value of PCI, five studies (Cox et al, 1981; Umsawasdi et al, 1984; Miller et al, 1998; Pöttgen et al, 2007; Gore et al, 2011) reported that PCI might reduce the incidence of BM; only one study (Russell et al, 1991) showed that PCI had no influence on the incidence of BM in NSCLC
Summary
Lung cancer is the leading cause of cancer deaths worldwide. Eighty-five percent of lung cancer patients are diagnosed yearly with non-small cell lung cancer (NSCLC). The incidence of brain metastases (BM) varies in patients with non-small cell lung cancer (NSCLC), calls into question the value of prophylactic cranial irradiation (PCI). We conducted the present meta-analysis on risk factors for BM and the value of PCI in patients with NSCLC. Compared with non-squamous cell carcinoma, squamous cell carcinoma was associated with a low incidence of BM in patients with NSCLC (p=0.000, pooled OR=0.47, 95% confidence interval =0.340.65). Conclusions: This meta-analysis provides statistical evidence that compared with non-squamous cell carcinoma, squamous cell carcinoma can be used as a predictor for BM in patients with NSCLC, and PCI might reduce the incidence of BM in patients with NSCLC, but does not provide a survival benefit
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