Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer

Radiation Oncology

Luhua Wang²  Jie He³  Weibo Yin²  Zongmei Zhou²  Jima Lv²  Jun Liang²  Wei Ji²  Zhouguang Hui²  Honghai Dai¹  Xiao Ding² 

[1] Department of oncology, Provincial Hospital Affiliated to Shandong University, Jinan, China;Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Pan jia yuan nan li 17#, Chao yang District, Beijing, 10021, China;Department of Thoracic Surgery, Cancer Hospital & Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

关键词: Lymph node ratio;    Non-squamous cell cancer;    Risk factors;    Prophylactic cranial irradiation;    Brain metastases;    Non-small cell lung cancer;   

Others  :  1228577
DOI  :  10.1186/1748-717X-7-119

 received in 2012-03-29, accepted in 2012-07-14,  发布年份 2012

【 摘 要 】

Background

Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset.

Methods

Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan–Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM.

Results

Fifty-three (24.4 %) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86–9.19; P = 0.001) and the ratio of metastatic to examined nodes or lymph node ratio (LNR) ≥ 30 % (RR: 3.33, 95 % CI: 1.79–6.18; P = 0.000) were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %.

Conclusions

In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.

【 授权许可】

   
2012 Ding et al.; licensee BioMed Central Ltd.

【 图 表 】

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