METHODS: Outcome data were collected for patients with advanced NSCLC attending a tertiary medical center between 2015 and 2020. Patients were stratified according to BM status and compared for overall survival (OS) using log-rank and Cox regression analyses.
RESULTS: The cohort included 360 patients with NSCLC of whom 134 (37.2%) had BM. Most (95%) of cases of BM developed within the first two years: 63% at diagnosis, 18% during the first year, 14% during the second year. There was no significant difference in OS between patients without BM and those with BM (median 23.7 vs. 22.3 months, HR = 0.97, p = 0.82); patients with BM and a targetable or non-targetable mutation (40.2 vs. 31.4 months, HR = 0.93, p = 0.84, and 20.7 vs. 19.87 months, HR = 0.95, p = 0.75, respectively); and patients with symptomatic BM (23.7 vs. 19.8 months, HR = 0.95, p = 0.78). Treatment for BM (95% of patients) consisted of stereotactic radiosurgery or tyrosine kinase inhibitors, with corresponding intracranial control rates of 90% and 86%.
CONCLUSIONS: The results imply that the presence of BM has no impact on the prognosis of NSCLC. The practice of excluding NSCLC patients with BM from clinical trials warrants reconsideration.
方法:收集2015年至2020年在三级医疗中心就诊的晚期NSCLC患者的预后数据。根据BM状态对患者进行分层,并使用log-rank和Cox回归分析比较总生存期(OS)。
结果:该队列包括360例NSCLC患者,其中134例(37.2%)患有BM。大多数(95%)的BM病例在头两年内发展:63%的诊断,第一年的18%,第二年为14%。无BM患者和有BM患者的OS无显著差异(中位数23.7vs.22.3个月,HR=0.97,p=0.82);患有BM和可靶向或非靶向突变的患者(40.2vs.31.4个月,HR=0.93,p=0.84,20.7与19.87个月,HR=0.95,p=0.75);和有症状的BM患者(23.7vs.19.8个月,HR=0.95,p=0.78)。BM(95%的患者)的治疗包括立体定向放射外科或酪氨酸激酶抑制剂,相应的颅内控制率为90%和86%。
结论:结果表明BM的存在对NSCLC的预后没有影响。将BM非小细胞肺癌患者排除在临床试验之外的做法值得重新考虑。