背景:脑转移(BrM)在NSCLC患者中普遍存在,和手术切除的BrM构成了一个有希望的局部管理和组织病理学诊断的治疗策略,尽管它是为一组选定的患者提供的。关于BrM切除术后的表现状态(PS)改善或随后的全身治疗分层的结果的信息有限。
方法:我们进行了一项回顾性单中心队列研究,包括手术切除BrM的NSCLC患者,重点关注PS的改善和BrM切除后的后续治疗。
结果:纳入71例患者,中位总生存期为18.3个月(95%置信区间[95%CI]:8.7,未达到).接受手术切除BrM的NSCLC患者的PS显着改善(18%和39%的患者在BrM切除前后显示ECOGPS为0-1,分别为[p=0.006]),PS改善的患者比PS未改善的患者年轻(中位数,62岁对66岁;p=0.041)。关于BrM切除术后的全身治疗,21例(30%)患者接受细胞毒性化疗,14例患者(20%)接受酪氨酸激酶抑制剂(TKIs),3名患者(4%)接受了免疫检查点抑制剂(ICIs),21例患者(30%)未接受后续治疗.通过随后的系统治疗进行分层的患者的生存结局表明,接受TKI或ICI的患者显示出更好的生存结局。尽管少数患者阻碍了统计比较。
结论:我们描述了接受BrM手术切除的NSCLC患者的预后,揭示年轻患者更有可能预期PS的改善,在BrM切除后接受TKI或ICI的患者往往表现出更好的预后。
BACKGROUND: Brain metastasis (BrM) is prevalent among patients with NSCLC, and surgical resection of BrM constitutes a promising treatment strategy for local management and histopathological diagnosis, although it is offered for a select group of patients. Limited information exists concerning the improvement in performance status (PS) following BrM resection or the outcomes stratified by subsequent systemic therapy.
METHODS: We conducted a retrospective single-center cohort study including NSCLC patients with surgically resected BrM and focused on the improvement in PS and subsequent therapy after BrM resection.
RESULTS: 71 patients were included, and the median overall survival was 18.3 months (95% confidence interval [95% CI]: 8.7, not reached). Patients with NSCLC who underwent surgical resection of BrM showed significant improvement in PS (18% and 39% showed ECOG PS of 0-1, before and after BrM resection, respectively [p = 0.006]), and patients with PS improvement were younger than those with PS unimprovement (median, 62 years versus 66 years; p = 0.041). Regarding subsequent systemic therapy after BrM resection, 21 patients (30%) received cytotoxic chemotherapy, 14 patients (20%) received tyrosine kinase inhibitors (TKIs), 3 patients (4%) received immune checkpoint inhibitors (ICIs), and 21 patients (30%) received no subsequent therapy. The survival outcomes of patients stratified by subsequent systemic treatments suggested the tendency that those who received TKI or ICI showed better survival outcomes, although a small number of patients hindered statistical comparisons.
CONCLUSIONS: We describe the outcomes of patients with NSCLC who underwent surgical resection of BrM, revealing that younger patients were more likely to anticipate improvement in PS, and patients who received TKI or ICI after BrM resection tended to exhibit a more preferable prognosis.