Abstract
Background and objectivesBrain metastases occur in about 30% of all patients with non-small cell lung cancer (NSCLC). In selected patients, long-term survival can be achieved by resection of brain metastases. In this retrospective study, we investigate the prognosis of NSCLC patients with resected brain metastases and possible prognostic factors.MethodsIn 119 patients with NSCLC and resected brain metastases, we report the following parameters: extent of resection, resection status, postoperative complications and overall survival (OS). We used the log-rank test to compare unadjusted survival probabilities and multivariable Cox regression to investigate potential prognostic factors with respect to OS.ResultsA total of 146 brain metastases were resected in 119 patients. The median survival was 18.0 months. Postoperative cerebral radiotherapy was performed in 86% of patients. Patients with postoperative radiotherapy had significantly longer survival (median OS 20.2 vs. 9.0 months, p = 0.002). The presence of multiple brain metastases was a negative prognostic factor (median OS 13.5 vs. 19.5 months, p = 0.006). Survival of patients with extracerebral metastases of NSCLC was significantly shorter than in patients who had exclusively brain metastases (median OS 14.0 vs. 23.1 months, p = 0.005). Both of the latter factors were independent prognostic factors for worse outcome in multivariate analysis.ConclusionsBased on these data, resection of solitary brain metastases in patients with NSCLC and controlled extracerebral tumor disease is safe and leads to an overall favorable outcome. Postoperative radiotherapy is recommended to improve prognosis.
Highlights
Lung cancer remains the leading cause of cancer death worldwide [1]
We investigate the prognosis of non-small cell lung cancer (NSCLC) patients with resected brain metastases and possible prognostic factors
A total of 146 brain metastases were resected in 119 patients
Summary
Brain metastases occur in 20% to 32% of patients diagnosed with NSCLC [2, 3], most frequently in patients with adenocarcinomas and tumors harboring EGFR mutations or ALK rearrangements with an incidence of up to 72% [4,5,6]. In some patients, brain metastases may not be clinically significant and remain undetected as shown in autopsy series where the incidence is reported to be up to 60% in unselected NSCLC patients [8]. Brain metastases occur in about 30% of all patients with non-small cell lung cancer (NSCLC). Long-term survival can be achieved by resection of brain metastases. Editor: Hyun-Sung Lee, Baylor College of Medicine, UNITED STATES Received: November 15, 2020 Accepted: June 8, 2021 Published: June 28, 2021
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