Abstract
BackgroundSurgery is an important approach to treat non-small cell lung cancer (NSCLC) brain metastases (BM). Here, we analyzed the survival outcome and prognostic factors for patients with NSCLC after BM resection.MethodsThe Surveillance Epidemiology and End Results (SEER) database was employed to address the incidence of BM from NSCLC and the current prognosis at population level. 674 contemporaneous NSCLC patients received BM resection at Sun Yat-sen University Cancer Center (SYSUCC) were used for survival comparison and Cox proportional hazards model was applied for identifying prognostic factors.Results60,436 NSCLC patients diagnosed between 2010 to 2017 were enrolled from SEER database. Among them, 8,708 (14.4%) BM were identified at primary NSCLC diagnosis (synchronous BM, SBM). Median overall survival (OS) of SBM was 6 months with 1-, and 3-year survival percentages of 30.3% and 9.8%, respectively. Furthermore, the survival of BM patients without extracranial metastasis is significantly longer than those with extracranial metastases (median OS: 10 versus 5 months, P<0.001). 225 SBM (cohort A) and 449 BM with treatment history on primary NSCLC (cohort B) were collected from SYSUCC. In cohort A, 86 BM with extracranial metastases were found (38.2%) and the median OS was significantly shorter than those without extracranial metastases (15.2 versus 23.7 months, P<0.001). In cohort B, 255 cases with extracranial metastases were found (56.8%) and their prognosis was also worse than cases without extracranial metastases (median OS: 18.3 versus 22.1 months, P=0.002). Multivariate analyses revealed that younger age (HR=0.71, P=0.003), without extracranial metastases (HR=0.65, P<0.001) and radiation for BM (HR=0.78, P=0.005) were independent factors for better OS.ConclusionImproved survival of patients received BM resection was observed in SYSUCC cohort as comparison with SEER patients with NSCLC and BM. Aggressive local treatment including surgery and radiation is still important in Modern management of BM from NSCLC.
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