학술논문
Assessment of Brain Metastasis at Diagnosis in Non-Small-Cell Lung Cancer: A Prospective Observational Study From North India.
Document Type
Academic Journal
Author
Naresh G; Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Malik PS; Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Khurana S; Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Pushpam D; Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Sharma V; Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Yadav M; Department of Radiodiagnosis, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.; Jain D; Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.; Pathy S; Department of Radiation Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India.
Source
Publisher: American Society of Clinical Oncology Country of Publication: United States NLM ID: 101760170 Publication Model: Print Cited Medium: Internet ISSN: 2687-8941 (Electronic) Linking ISSN: 26878941 NLM ISO Abbreviation: JCO Glob Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: The incidence of symptomatic brain metastasis at diagnosis in non-small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC.
Materials and Methods: This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage.
Results: A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly.
Conclusion: In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.
Competing Interests: Prabhat Singh MalikResearch Funding: BMS India Pvt Ltd Deepam PushpamStock and Other Ownership Interests: Caplin Point LaboratoriesNo other potential conflicts of interest were reported.
Materials and Methods: This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage.
Results: A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly.
Conclusion: In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.
Competing Interests: Prabhat Singh MalikResearch Funding: BMS India Pvt Ltd Deepam PushpamStock and Other Ownership Interests: Caplin Point LaboratoriesNo other potential conflicts of interest were reported.