Clinicopathological prognostic factors in operated for lung cancer and brain metastasis patients

Abstract

Background: About 40% of patients with lung cancer (LC)develop brain metastases(BM). The prognosis is poor. The study of BM is important for better understanding the biology of LC. Aim: To study the prosnostic significance of TTF-1, p63, Ki-67, CD31 expression in operated for LC and BM patients. Methods: Surgically resected BMs and their corresponding primary LCs from 30 patients (men n=25, 83%; age 55±9) were studied: adenocarcinoma (AC)-21, squamous cell carcinoma(SCC)-5, small cell lung carcinoma(SCLC)-4. The histological subtype, immunohistochemical expression of TTF-1, p63, Ki-67(proliferative activity) and CD31 (number intratumoral microvessels-NIM)and survival(in 25 cases)were evaluated. Results: 24 (80%) patients were first operated for LC and 1 month to 1.5 years later – for BM. If the patient was first operated for BM (n=6, 20%) then 44±23 days later was operated for LC. It was found that the 1-year survival rate after surgery for LC has higher (68%vs.36%) and longer mean survival (554±801vs.269±809 days) compared to those after surgery for BM. Depending on the histological type of the tumor survival after surgery of the lung was significantly longer in the AC compared with SCLC (712vs.150days, p=0.017). There was a tendency after surgery on the brain for decreased survival in terms of SCC compared with AC (192vs.339, p=0.09). Negative prognostic factors were found after surgery for LC- SCLC histology and Ki-67> 18%. Such factors were not found in terms of survival after surgery for BM. Conclusion: SCLC histology and Ki-67> 8% may represent negative prognostic factors after surgery for LC with BM. Supported by Grant 360/2015-Contract Nr.76/2015 funded by Medical University, Sofia.