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Abstract：
BACKGROUND: Historically, patients with brain metastasis (BM) have been excluded from clinical trials investigating treatments for non-small cell lung cancer (NSCLC) due to their unfavorable prognosis. Advanced treatments have increased survival prospects for NSCLC patients with BM. This study evaluated the life expectancy of NSCLC patients with and without BM in the context of contemporary treatments.
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.
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.
摘要：
背景：历史上，脑转移(BM)患者因预后不良而被排除在非小细胞肺癌(NSCLC)治疗的临床试验之外.晚期治疗增加了患有BM的NSCLC患者的生存前景。这项研究评估了在当代治疗背景下，有和没有BM的NSCLC患者的预期寿命。
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。
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。
