Risk of cerebral metastases for postoperative locally advanced non-small-cell lung cancer

Abstract

Background Cerebral metastases are the main determining factor in the failure of locally advanced non-small-cell lung cancer (NSCLC) management. Our study assessed the risk factors of brain metastases in patients with postoperative, locally advanced NSCLC. Implications for PCI treatment are discussed. Methods Two hundred twenty-three patients treated with surgical resection for stage III-N2 NSCLC were retrospective analyzed to elucidate risk factors for development of brain metastases, and to establish a mathematical model. Results Median survival time for this patient population was 29.5 months. Frequency of brain metastases in the entire patient population was 38.1% (85/223). Frequency of brain metastases in patients with single mediastinal lymph-node region with metastases at 1, 2, and 3 years was 5.6%, 14.0%, and 19.0%, respectively. The frequency of brain metastases in patients with multiple mediastinal lymph-node regions with metastases was 31.8%, 60.3%, 68.0%, respectively ( P < 0.001). The frequency of brain metastases among patients with mediastinal metastasis number less than 4, 4–6, and more than 6 was significantly different ( P < 0.001). There were also significant differences in brain metastases frequency between patients with complete versus incomplete resection ( P = 0.001), and patients with non-squmous versus squamous ( P = 0.029), and patients administered adjuvant chemotherapy versus none ( P = 0.032). Conclusion A mathematical model to predict brain metastases risk was developed. It can aid in selection of patients with locally advanced NSCLC for PCI in clinical trails.