Factors For Brain Metastases Research Articles

Analysis of high‑risk factors for brain metastasis and prognosis after prophylactic cranial irradiation in limited‑stage small cell lung cancer.

Small cell lung cancer (SCLC) is an aggressive malignancy with a high propensity for brain metastases (BM). Limited-stage SCLC (LS-SCLC) can be effectively treated with chemoradiotherapy and prophylactic cranial irradiation (PCI) to enhance patient outcomes. The aim of the present study was to assess the risk factors and prognostic significance of brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) who attained complete remission (CR) or partial remission (PR) following combined chemoradiotherapy and subsequent prophylactic cranial irradiation (PCI). Data for 290 patients diagnosed with LS-SCLC and treated at Chengde Central Hospital and Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine (Chengde, China), who achieved CR or PR and underwent PCI between 2015 and 2023, were retrospectively analyzed. BM rates and overall survival (OS) were estimated using the Kaplan-Meier method, whilst differences were assessed using the log-rank test. Risk factors affecting BM and OS were assessed using univariate and multivariate Cox regression analyses. The overall incidence of BM after PCI was 16.6% (48/290), with annual rates of 1.4, 6.6 and 12.8% at 1, 2 and 3 years, respectively. Multivariate Cox regression analysis identified an initial tumor size of >5 cm [hazard ratio (HR)=15.031; 95% confidence interval (CI): 5.610-40.270; P<0.001] as a significant independent risk factor for BM following PCI. The median OS was 28.8 months and the 5-year OS rate was 27.9%. The median OS for patients with and without BM at 27.55 and 32.5 months, respectively, and the corresponding 5-year OS rates were 8.3 and 31.8%, respectively (P=0.001). Median OS rates for stages I, II and III were 61.15, 48.5 and 28.4 months, respectively, with 5-year OS rates of 62.5, 47.1 and 21.6%, respectively (P<0.001). Further multivariate Cox regression analysis indicated that BM (HR=1.934; 95% CI: 1.358-2.764; P<0.001) and clinical stage (HR=1.741; 95% CI: 1.102-2.750; P=0.018; P=0.022) were significant independent risk factors associated with patient OS. In conclusion, a tumor size of >5 cm is a significant risk factor for BM following PCI in patients with LS-SCLS achieving CR or PR through radiotherapy and chemotherapy. Furthermore, BM and clinical staging independently influence OS.

Risk and prognostic factors of brain metastasis in lung cancer patients: a Surveillance, Epidemiology, and End Results population‑based cohort study.

Brain is a common metastasis site in lung cancer patients. However, homogeneous and heterogeneous risk/prognostic factors of brain metastasis for lung cancer patients have not been comprehensively elucidated. This study aimed to explore the brain metastasis risk and prognostic factors in lung cancer patients using the Surveillance, Epidemiology, and End Results (SEER) database. Lung cancer data were downloaded from SEER database to investigate risk factors for developing brain metastasis using logistic regression analysis. Univariate and multivariate Cox analyses were used to identify potential prognostic factors. Kaplan-Meier analysis was conducted to evaluate the survival. Propensity score matching was conducted to eliminate baseline differences between two groups. A total of 10 818 (14.1%) patients with brain metastasis were diagnosed among 76 483 lung cancer patients. For non-small-cell lung carcinoma (NSCLC), distant liver/bone/lymph node metastases, higher T, N stages were risk factors. Black race, bone metastases and distant lymph node metastases and T4 were brain metastasis risk factors for SCLC patients. Cox analysis suggested that older age, male, primary lesion at main bronchus, liver/ bone/distant lymph node metastases, T2-4, N1-3, no surgery/chemotherapy/radiotherapy were associated with worse prognosis of NSCLC-brain metastasis patients. Age older than 80, liver/bone metastases, without radiotherapy and chemotherapy were associated with worse prognosis of SCLC-brain metastasis patients. Surgery of primary site could prolong the overall survival (OS) of NSCLC patients with brain metastasis, but not SCLC. In this study, we analyzed the homogeneous and heterogeneous risk/prognostic factors of brain metastasis in lung cancer patients. What is more, our results showed that surgery of primary site was associated with longer OS of NSCLC patients with brain metastasis.

Survival and Prognostic Factors in Brain Metastases from Breast Cancer Treated with Stereotactic Radiotherapy

Abstract AIMS Intracranial metastases are common in patients with breast cancer. Stereotactic radiotherapy (SRT) can improve overall survival (OS) in selected patients; however there is uncertainty over the presence of prognostic indicators in this cohort. Here, we aim to determine whether the number of brain metastases, receptor status and presence of extracranial disease affected OS. METHOD Retrospective analysis was performed for all patients receiving SRT for brain metastases from breast cancer between 2014-2020 at Barts Cancer Centre. Overall survival (OS) was calculated using the Kaplan-Meier method. Differences between groups were assessed using the Log-rank (Mantel-cox) test. RESULTS 109 patients with a histopathologically confirmed diagnosis of breast cancer were included. The median age at treatment was 52 years (IQR:46-60). Of 103 patients with documented receptor status, 22 patients were ER+/HER2+, 32 ER+/HER2-, 20 ER-/HER2+ and 29 triple-negative. 68/105 patients had extra-cranial metastatic disease at treatment with SRT. A median of 2 lesions were treated per patient (range:1-15). Median OS for all patients was 67.4 weeks. Median OS was 91.4 weeks for ER+/HER2+ patients, 64.9 weeks for ER+/HER- patients, 71.4 weeks for ER-/HER2+ and 37 weeks for ER-/HER2- (p=0.001). Median OS was 55.1 weeks for patients with extra-cranial metastatic disease and 91.4 weeks in those without (p=0.017). Median OS was 72.1 weeks in patients with 1-2 brain metastases and 53.7 in those with extensive (3+) brain metastases, however this was not statistically significant (p=0.892). CONCLUSION A trend towards worse OS in patients with triple-negative receptor status and extra-cranial metastatic disease at treatment with SRT warrants further investigation.

Analysis of microRNAs in Exosomes of Breast Cancer Patients in Search of Molecular Prognostic Factors in Brain Metastases.

Brain metastases are the most severe tumorous spread during breast cancer disease. They are associated with a limited quality of life and a very poor overall survival. A subtype of extracellular vesicles, exosomes, are sequestered by all kinds of cells, including tumor cells, and play a role in cell-cell communication. Exosomes contain, among others, microRNAs (miRs). Exosomes can be taken up by other cells in the body, and their active molecules can affect the cellular process in target cells. Tumor-secreted exosomes can affect the integrity of the blood-brain barrier (BBB) and have an impact on brain metastases forming. Serum samples from healthy donors, breast cancer patients with primary tumors, or with brain, bone, or visceral metastases were used to isolate exosomes and exosomal miRs. Exosomes expressed exosomal markers CD63 and CD9, and their amount did not vary significantly between groups, as shown by Western blot and ELISA. The selected 48 miRs were detected using real-time PCR. Area under the receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy. We identified two miRs with the potential to serve as prognostic markers for brain metastases. Hsa-miR-576-3p was significantly upregulated, and hsa-miR-130a-3p was significantly downregulated in exosomes from breast cancer patients with cerebral metastases with AUC: 0.705 and 0.699, respectively. Furthermore, correlation of miR levels with tumor markers revealed that hsa-miR-340-5p levels were significantly correlated with the percentage of Ki67-positive tumor cells, while hsa-miR-342-3p levels were inversely correlated with tumor staging. Analysis of the expression levels of miRs in serum exosomes from breast cancer patients has the potential to identify new, non-invasive, blood-borne prognostic molecular markers to predict the potential for brain metastasis in breast cancer. Additional functional analyzes and careful validation of the identified markers are required before their potential future diagnostic use.

Predictive Indicators of Brain Metastasis-Free Survival in Patients With Lung Cancer at a Chinese Cancer Center.

IntroductionMetastasis tumors of the brain derive mostly from lung cancer, breast cancer, melanoma, and more commonly among lung cancer patients. Once brain metastasis is diagnosed, the prognosis of untreated patients is shown to be very poor. In this study, we describe the clinical and pathological features of patients with lung cancer at our institution from 2009 to 2021. We also examined factors like gender, type, size, and location of the primary tumor and leukoaraiosis level at the first visit are associated with patients’ brain metastasis-free survival (the time free of brain metastases since the first diagnosis of lung cancer).Materials and methodsWe retrospectively reviewed patients with a final histologic diagnosis of lung cancer from September 2009 to January 2015. The evaluation included history, physical examination, and contrast-enhanced computerized tomography of the chest. Contrast-enhanced magnetic resonance imaging of the head was performed at the first visit and following treatment. The patients’ age, gender, tumor size, histology type, location of the lung tumor, and leukoaraiosis level at the first visit were recorded and correlated to the patients’ brain-metastasis-free survival time.ResultsThe study included 68 patients - 39 males and 29 females -with a mean age of 55.15 years (range 35-69 years). Adenocarcinoma was diagnosed in 47 patients (22 males and 25 females), Squamous carcinoma was diagnosed in 12 patients (9 males and 3 females), non-small cell lung carcinoma was diagnosed in 3 patients (2 males and one female), one male patient had the diagnosis of adenosquamous tumor and 1 male patient had the diagnosis of neuroendocrine tumor. Tumor size was <3 cm in 19 patients, 3-5 cm in 29 patients, 5-10 cm in 17 patients, and three other patients’ size was hard to measure. Of the 68 patients, 10 patients were detected as brain metastasis by magnetic resonance imaging at first diagnosis, 22 patients were diagnosed as brain metastasis during the follow-up visits, 36 patients were not found as brain metastasis until the last visit. According to the Cox regression univariate analysis, two factors were correlated to shorter brain metastasis-free survival: Not-squamous lung carcinoma (SCC) and higher location of the tumor. The multivariate statistical analysis correlated two factors to shorter brain metastasis-free survival: non-SCC histology type and age≥62.ConclusionsIn conclusion, we found that SCC had a lower incidence of brain metastasis in patients than other lung cancer types. According to the Cox regression multivariate analysis, age <62 and SCC were two protective factors of brain metastasis. According to the Cox regression univariate and analysis. The lower location of the tumor was the protective factor of brain metastasis. According to the Cox regression univariate analysis, other parameters, such as gender or tumor size, did not have a role in brain metastasis-free survival in these patients.

The risk and prognostic factors for brain metastases in esophageal cancer patients: an analysis of the SEER database

BackgroundBrain metastases were rare in esophageal cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, the present study investigated the incidence, risk and prognostic factors of brain metastases in esophageal cancer patients.MethodsRetrieving esophageal cancer patients diagnosed between 2010 and 2018 from the SEER database, univariable and multivariable logistic and cox regression models were used to investigate the risk factors for brain metastases development and prognosis, respectively. The brain metastases predicting nomogram was constructed, evaluated and validated. The overall survival (OS) of patients with brain metastases was analyzed by Kaplan–Meier method.ResultsA total of 34,107 eligible esophageal cancer patients were included and 618 of them were diagnosed with brain metastases (1.8%). The median survival of the brain metastatic esophageal cancer patients was 5 (95% CI: 5–7) months. The presence of bone metastases and lung metastases were the homogeneously associated factors for the development and prognosis of brain metastases in esophageal cancer patients. Patients younger than 65 years, American Indian/Alaska Native race (vs. White), overlapping lesion (vs. Upper third), esophageal adenocarcinoma histology subtype, higher N stage, and liver metastases were positively associated with brain metastases occurrence. The calibration curve, ROC curve, and C-index exhibited good performance of the nomogram for predicting brain metastases.ConclusionsHomogeneous and heterogeneous factors were found for the development and prognosis of brain metastases in esophageal cancer patients. The nomogram had good calibration and discrimination for predicting brain metastases.

Brain metastases in gastroesophageal cancers\u2014an underestimated complication

BackgroundBrain metastases represent a severe complication in many gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastroesophageal junction, and stomach (GEC). However, there is little knowledge about the onset or potential risk factors for brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs.MethodsWe analyzed 827 patients from our cancer registry suffering from gastroesophageal cancer (GEC) and treated at the University Medical Center Göttingen between January 2013 and December 2019 for the presence of BRMs.ResultsFrom 827 patients with GEC we found 54 patients with BRMs, resulting in an incidence of 6.5%. BRMs are more frequent in male patients (90.74% vs 9.26%, p = 0.0051) and in adenocarcinomas (90.74% vs 9.26%, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in limited disease (curative approach) and 9.3 months in advanced disease (palliative approach) (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with successful resection of BRMs have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091).ConclusionIn this single-center retrospective study, brain metastases (BRMs) occur with a high frequency (6.5%) in gastroesophageal cancer (GEC), significantly more often in male patients and adenocarcinomas. Since survival of these patients considerably correlates with successful BRMs resection, our observations propose further prospective trails to validate our hypothesis and ultimately the implementation of routine screening procedures to detect asymptomatic brain metastases.

PO-1255: Prognostic factors in brain metastases from breast cancer treated with Cyberknife

PO-1255: Prognostic factors in brain metastases from breast cancer treated with Cyberknife

Clinical Analysis of Predicting Factors for Brain Metastasis in Patients with Limited-Stage Small-Cell Lung Cancer after Thoracic Radiotherapy

Clinical Analysis of Predicting Factors for Brain Metastasis in Patients with Limited-Stage Small-Cell Lung Cancer after Thoracic Radiotherapy

Radiomics as prognostic factor in brain metastases treated with Gamma Knife radiosurgery.

Gamma Knife radiosurgery (GKRS) is a non-invasive procedure for the treatment of brain metastases. This study sought to determine whether radiomic features of brain metastases derived from pre-GKRS magnetic resonance imaging (MRI) could be used in conjunction with clinical variables to predict the effectiveness of GKRS in achieving local tumor control. We retrospectively analyzed 161 patients with non-small cell lung cancer (576 brain metastases) who underwent GKRS for brain metastases. The database included clinical data and pre-GKRS MRI. Brain metastases were demarcated by experienced neurosurgeons, and radiomic features of each brain metastasis were extracted. Consensus clustering was used for feature selection. Cox proportional hazards models and cause-specific proportional hazards models were used to correlate clinical variables and radiomic features with local control of brain metastases after GKRS. Multivariate Cox proportional hazards model revealed that higher zone percentage (hazard ratio, HR 0.712; P = .022) was independently associated with superior local tumor control. Similarly, multivariate cause-specific proportional hazards model revealed that higher zone percentage (HR 0.699; P = .014) was independently associated with superior local tumor control. The zone percentage of brain metastases, a radiomic feature derived from pre-GKRS contrast-enhanced T1-weighted MRIs, was found to be an independent prognostic factor of local tumor control following GKRS in patients with non-small cell lung cancer and brain metastases. Radiomic features indicate the biological basis and characteristics of tumors and could potentially be used as surrogate biomarkers for predicting tumor prognosis following GKRS.

Therapeutic results and prognostic factors of brain metastases from breast cancer: Single center experience.

Therapeutic results and prognostic factors of brain metastases from breast cancer: Single center experience.

PO-0751 Neutrophil lymphocyte ratio and Platelet lymphocyte ratio as a prognostic factor in brain metastases

PO-0751 Neutrophil lymphocyte ratio and Platelet lymphocyte ratio as a prognostic factor in brain metastases

Prognostic role of the systemic immune-inflammation index in brain metastases from lung adenocarcinoma with different EGFR mutations.

The prognostic value of the systemic immune-inflammation index (SII) has been shown in various types of cancers. We aimed to evaluate the predictive values in brain metastases from lung adenocarcinoma with status of EGFR mutations. We, retrospectively, examined 310 patients with brain metastases from lung adenocarcinoma with status of EGFR mutations. SII was calculated using P * N/L, where P, N, and L, respectively refer to peripheral blood lymphocyte, neutrophil, and platelet counts. The cut-off value of SII was assessed by area under the curve (AUC). The log-rank test and Cox proportional hazard model were used to confirm the impact of SII and other variables on survival. The SII value ≤ 1218.81 was associated with prolonged survival in patients with brain metastases from lung adenocarcinoma in both variable and multivariable analysis In patients with EGFR mutations, the SII had statistical effect on OS only in invariable test. While, for patients with wild-type EGFR, SII achieved statistically significant differences both in variable and multivariable analyses. SII is an independent prognostic factor in brain metastases from lung adenocarcinoma. SII may have varying prognostic effects on patients with and without EGFR mutations and is a promising variable for the future prognostic systems.

Association of the prognostic nutrition index with overall survival time of the patients with brain metastases of lung adenocarcinoma

Objective To explore the effect of prognostic nutrition index (PNI) on the overall survival time of patients with brain metastases of lung adenocarcinoma. Methods A retrospective analysis was performed on the clinic data of 274 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma from May 2013 to May 2016. The prognosic factors for brain metastases such as PNI, gender, age, smoking history, epidermal growth factor receptor (EGFR) mutation status, Karnofsky performance status (KPS) score, the number of brain lesions, treatment of brain lesions, extracranial metastases and the status of primary disease were analyzed. The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of PNI, and the patients were divided into high PNI group and low PNI group. The univariate and multivariate prognostic analyses were performed by the Log-rank test and the Cox proportional hazards model. Results The patients were divided into high PNI (>50.45) group (n=72) and low PNI (≤50.45) group (n=202). The median overall survival (OS) was 11.20 months in all patients with brain metastases, and the median OS of the low PNI group and high PNI group were 10.13 months and 15.17 months respectively. The univariate analysis results showed that gender (χ2=5.459, P=0.019), age (χ2=3.986, P=0.046), smoking or not (χ2=6.878, P=0.009), EGFR mutation status (χ2=20.484, P<0.001), KPS score (χ2=126.573, P<0.001), extracranial metastases or not (χ2=4.403, P=0.036), treatment on the brain lesions (χ2=40.444, P<0.001) and PNI (χ2=7.972, P=0.005) were related to the prognosis. The Cox multivariate analysis results showed that age (HR=1.580, 95%CI: 1.104-2.295, P=0.012), EGFR mutation status (HR=0.549, 95%CI: 0.408-0.738, P<0.001), KPS score (HR=0.077, 95%CI: 0.045-0.134, P<0.001), treatment on brain metastases (HR=0.882, 95%CI: 0.789-0.987, P=0.029) and PNI (HR=0.614, 95%CI: 0.437-0.861, P=0.005) were related to the prognosis. Conclusion PNI is an independent prognostic predictor of brain metastases in patients with lung adenocarcinoma, and the high-PNI is correlated to the long OS of patients with brain metastases of lung adenocarcinoma, which has certain clinical practical value. Key words: Carcinoma, non-small-cell lung; Neoplasm metastasis, brain; Nutrition assessment; Prognosis

Risk factors of brain metastasis of lung squamous cell carcinoma: a retrospective analysis of 188 patients from single center

BackgroundTo explore risk factors and the efficacy of treatment strategies for brain metastasis (BM) in squamous cell carcinoma (SCC) of the lung.MethodsThe clinical data of 188 pathologically confirmed as squamous cell carcinoma or adenosquamous carcinoma patients were studied retrospectively. Factors including age (<60 vs. ≥60), gender, stage at diagnosis, T status (T1–2 vs. T3–4), N status (N0–1 vs. N2–3), histology (squamous vs. adenosquamous), smoking history (non-smoker vs. current smoker) and serum tumor markers (normal vs. elevated) were analyzed.ResultsThe incidence of BM was 19.1% (36/188) in our cohort. Patients who were female (p = 0.005), had advanced disease at diagnosis (p < 0.001), had adenosquamous carcinoma histology (p = 0.033) or had elevated serum level of CEA at diagnosis (p < 0.001) had significantly higher incidence of BM. In multivariate analysis, female (p = 0.034, HR = 18.874) and elevated serum level of CEA at diagnosis (p = 0.009, HR = 19.824) were independent risk factors of BM. BM patients who received additional systemic therapy after local therapy had significantly longer post-BM survival than those who received local therapy only (p = 0.004, HR = 0.058). Gemcitabine/platinum-containing regimen (GP) and taxans/platinum-containing regimen (TP) led to comparable brain-metastasis-free survival (BMFS) (p = 0.10).ConclusionsFemales and patients with elevated serum level of CEA at diagnosis had a higher risk of developing BM. The following systemic therapy after local therapy prolonged the survival of BM patient, but the efficacy of GP and TP was comparable in terms of preventing BM.

Analysis of survival-and prognosis-related factors of brain metastasis from esophageal cancer

Objective To explore the incidence of brain metastases from esophageal cancer, survival-related factors after brain metastases, and the result of different treatment methods. Methods From January 2000 to October 2016 treated 11 338 cases of esophageal cancer patients, 84 cases of brain metastases, were collected with complete clinical data. Results Eighty four cases of patients with brain metastases included esophageal squamous carcinoma in 74 cases, adenocarcinoma in 6 cases, and small cell undifferentiated carcinoma 4 cases; single brain metastases in 19 cases, 65 cases of multiple brain metastases included 59 cases with brain metastasis symptoms, 58 with extracranial metastases, primary tumors and brain metastases interval time less than 6 months in 31 cases, 24 cases of 6-12, 16 cases for 12-24 months. Prognostic logrank univariate analysis of survival rate found 24-36 months survival for 13 patients. All patients were followed for a median of 19.31 months after brain metastases, the median survival time was 5.43 months. Conclusions About 0.7% of brain metastases from esophageal cancer occurs. Esophageal carcinoma metastatic to the brain: There was no extracranial metastasis, recursive partitioning analysis classification (RPA), Karnofsky (KPS) score, brain metastases different treatment methods is a poor prognostic factor for esophageal cancer brain metastasis. Key words: Stomach neoplasms/ME/DI; Brain neoplasms/SC/EP; Survival rate; Prognosis

Risk factors associated with brain metastases in ECOG-ACRIN E1505, a phase III randomized trial of adjuvant chemotherapy with or without bevacizumab for patients with completely resected stage IB (&gt;/= 4 cm) - IIIA non-small cell lung cancer (NSCLC).

8539 Background: ECOG-ACRIN E1505 was a phase III randomized trial of adjuvant chemotherapy with or without bevacizumab for patients with completely-resected Stage IB (&gt;4CM) – IIIA non-small cell lung cancer. Prior studies have shown that the risk of brain recurrence in patients after definitive surgical resection is approximately 10%; however, covariates associated with development of brain recurrence have varied across these studies. We sought to estimate the incidence of and risk factors for brain recurrence. Methods: Among the 1501 patients enrolled to ECOG-ACRIN E1505, 121 patients developed brain metastases as their first site of recurrence and are the subject of this investigation. All 1501 patients underwent a pneumonectomy (N = 192) or (bi)lobectomy and had an R0 resection. The cumulative incidence of brain recurrence was estimated after adjusting for recurrence at other sites and death as competing events. A multivariable regression model was fitted using the methodology of Fine and Gray to evaluate the effect of covariates on the subdistribution of brain recurrence. Results: With a median follow-up of 50.3 months, a total of 121 brain metastases had been reported as the first site of recurrence. The incidence of brain recurrence at 12 months post-randomization was 3.7% (95% CI: 2.8% – 4.7%), and it increased to 8.5% (95% CI: 7.0% - 10.0%) at 3 years, and to 9.9% (95% CI: 8.0% - 11.7%) at 6 years. Risk factors for brain metastases included pneumonectomy(HR=1.8; p=0.01), and nonsquamous histology(HR=2.04; p=0.003), but bevacizumab(HR=0.64; p=0.02) was associated with potentially protective effect. Conclusions: The cumulative incidence of brain recurrence increased over time to 9.9% at 6 years in this population of patients with surgically-resected non-small cell lung cancer. Treatment, tumor histology, and type of resection appear to be associated with the risk of brain recurrence. Clinical trial information: NCT00324805.

Association between epidermal growth factor receptor mutation subtypes and the prognosis of brain metastases in patients with lung adenocarcinoma

Objective To explore the association between epidermal growth factor receptor (EGFR) mutation subtypes and the prognosis of brain metastasis in patients with lung adenocarcinoma. Methods A retrospective analysis was performed on the clinical data of 256 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma by EGFR mutation detection from 2010 to 2015. The prognostic factors for brain metastases were analyzed. The survival rate was calculated by the Kaplan-Meier method and analyzed by the log-rank test. The univariate and multivariate prognostic analyses were performed by the log-rank test and the Cox proportional hazards model. Results The median survival time was 10.13 months in all patients. The univariate analysis showed that sex, EGFR mutation status, exon 19 deletion, the Karnofsky Performance Status (KPS) score of brain metastases, and targeted therapy were prognostic predictors (P=0.006, 0.001, 0.010, 0.000, 0.003). The multivariate analysis showed that the KPS score and exon 19 deletion were prognostic factors for brain metastases (P=0.000, 0.045). When grouped into the recursive partitioning analysis classes, all the patients were split into three subgroups with significantly different prognosis (P=0.000). Conclusions Exon 19 deletion is a prognostic predictor of brain metastases in patients with lung adenocarcinoma, which can be integrated into the prognosis scoring system for brain metastases of lung adenocarcinoma. EGFR tyrosine kinase inhibitors improve the survival in patients with brain metastases of lung adenocarcinoma and EGFR mutation, particularly, in those with exon 19 deletion. Key words: Neoplasm metastasis, brain; Lung neoplasms; Epidermal growth factor receptor; Prognosis

BMET-05. EVALUATION OF SURVIVAL FOLLOWING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES FROM BREAST CANCER

We examined the impact of patient- and tumor-specific factors on overall survival in patients with breast brain metastases cancer treated with SRS. We conducted a single-institution IRB-approved retrospective chart review on 47 patients with 158 total breast cancer brain metastases treated with linear accelerator-based SRS between November 2008 and January 2014. Patients included in the study were treated with SRS and had at least one follow-up MRI. Survival was defined as the interval from initial SRS treatment to death. Actual survival was calculated using the Kaplan-Meier method with 95% confidence intervals. Multiple parameters were evaluated for potential relation to survival including prior WBRT, KPS at initial presentation, and histological subtype. Log rank tests were used to evaluate the impact of these parameters on survival. The median follow-up of all metastases was 5.9 months. There was a significant difference in median survival between patients with KPS 90 versus KPS 70 (P=0.032). There was no significant difference in median survival in patients with: prior WBRT (9.59 months, P=0.19); ER positive tumor makers (15.97 months, P=0.56); PR positive tumor markers (20.01 months, P=0.17); HER2 positive tumor markers (14.32 months, P=0.51). Our study supports previous research and further evaluated KPS as significant prognostic factor in brain metastases from breast cancer. Prior WBRT, ER positive, PR positive, and HER2 positive mutation status did not have a significant effect on overall survival following SRS for brain metastases from breast cancer in our study. The assessment of the impact of prior WBRT was limited by the small number of patients with these abnormalities in the study group. These results support the use of SRS for good performance breast cancer patients regardless of marker status.

An analysis of risk factors for brain metastases after prophylactic cranial irradiation for limited-stage small-cell lung cancer

Objective To evaluate the high-risk factors for brain metastases after prophylactic cranial irradiation (PCI), and to provide a basis for personalized treatment. Methods A retrospective analysis was performed in 188 patients with limited-stage small-cell lung cancer who received PCI in our hospital from 2005 to 2010. The Kaplan-Meier method was used to calculate the cumulative rate of brain metastases. The log-rank test and the Cox model were used for the univariate and multivariate analyses of the potential factors for the cumulative incidence of brain metastases, respectively. Results In the 188 patients, 31(16.5%) had brain metastases. The 1-, 2-, and 3-year cumulative incidence rates of brain metastases were 4%, 15%, and 20%, respectively. The univariate analysis showed that staged Ⅲ disease before treatment, elevated levels of tumor markers, incomplete remission after chemoradiotherapy, and local-regional relapse were risk factors for high incidence of brain metastases (P=0.044, 0.037, 0.005, 0.007). The multivariate analysis revealed that incomplete remission after chemoradiotherapy and local-regional relapse after chemoradiotherapy were risk factors for high incidence of brain metastases after PCI (P=0.003, 0.040). Conclusions Patients with incomplete remission or local-regional relapse after chemoradiotherapy have high incidence of brain metastases after PCI. For those patients, a frequent follow-up of the central nervous system plus salvage cranial irradiation might provide an alternative to PCI. Key words: Small cell carcinoma, lung/prophylactic cranial irradiation; Brain metastasis; Risk factor