The prognostic implication of brain metastasis (BM) in patients with advanced non-small cell lung cancer (NSCLC)

Abstract

7268 Background: Patients (pts) with NSCLC and BM tend to have a poor outcome. However, the evolution of new management approaches to BM may impact the disease outcome. This study evaluated various prognostic factors in pts with advanced NSCLC with and without BM. Methods: A retrospective analysis of all patients with stage IV NSCLC at presentation managed at our institution between June, 1999 and June, 2003 was conducted. Bivariate analysis of overall survival (OS) with other factors including age, gender, race, histology, comorbidities, albumin, hemoglobin, presence and number of BM, and treatment types provided was conducted. A multivariate analysis was then performed on the aforementioned variables for each group. Results: Two hundred pts were included in the study with a median age 62 years (35–100). 58% were males, 61% were Caucasians, 37% African Americans. 139 pts (69%) had adenocarcinoma, 61 pts (31%) had squamous cell carcinoma. 74 pts (37%) had BM; 23 pts (31%) received stereotactic radiosurgery (STR) based treatment, 39 pts (53%) received non-STR based treatment such as WBRT and craniotomy, and 12 pts (16%) were not treated. The absence of BM was an independent adverse prognostic factor. The median survival (MS) of pts with BM was 6 months (1–29) compared to 5 months (1–45) for pts without BM (P value < 0.008). Among pts with BM, those who received STR-based treatment had a MS of 10 months (1–29) compared to 5 months (1–45) for those who did not receive STR (0.023). This was independent of the number of brain lesions. Other independent adverse prognostic factors included lack of treatment for BM, and low albumin (< 3.5 gm/dl). Conclusion: The presence of BM in our study of pts with advanced NSCLC did not adversely affect the patient outcome which is dependent on the type treatment administered. Low albumin is an independent adverse factor for pts with advanced NCSCLC. No significant financial relationships to disclose.