Surgical, histopathologic, and patient-related factors associated with isolated brain metastases (IBM) in patients with stages I-IIIA non-small cell carcinoma (NSCLC) undergoing surgical resection in comparison with patients developing other distal metastases (ODM).

Abstract

7542 Background: To assess surgical, histopathologic, and patient-related factors associated with isolated brain metastases (IBM) in patients with stages I-IIIA non-small cell carcinoma (NSCLC) who underwent a definitive surgical resection ± adjuvant chemotherapy as compared to patients developing other distal metastases (ODM). Methods: 593 consecutive patients who underwent a definitive surgical resection ± adjuvant chemotherapy for NSCLC from 2000–2007 were qualified for analysis if they did not receive any adjuvant/neo-adjuvant radiotherapy, had at least three months of follow-up, and did not have a history of other cancers within 5 years of the diagnosis of their NSCLC. Univariate and multi-variate analyses were performed to assess risk factors for IBM as the only site of metastatic relapse and compare these risk factors to those of patients with ODM. Results: After a median follow-up of 33 months, 92 patients (25 IBM and 67 ODM) presented with distal metastases. Median time to the development of IBM and ODM was 10 (range 1-42) and 12 months (range 1-74) respectively. IBM was the most common site of isolated distal failure (DF) occurring with a rate of 3, 5, and 9% at 1, 2, and 4 years. ODM occurred with a rate of 6, 11, and 21% at 1, 2, and 4 years. Risk factors for IBM included peri-neural invasion, adenocarcinoma, pneumonectomy, weight loss, and post-surgical transfusion by multivariate analysis. Risk factors for ODM include presence of hemoptysis, receipt of post-surgical transfusion, N stage, number of positive nodes by multi-variate analysis. Conclusions: IBM was the most common cause of isolated distal failure in patients undergoing surgical resection of NSCLC. Other than post-surgical transfusion, risk factors for IBM are different than those for ODM. Patients with adenocarcinoma, especially those with peri-neural invasion should be considered for routine radiographic brain surveillance after undergoing surgical resection of NSCLC.