Risk factors of brain metastasis during the course of EGFR-TKIs therapy for patients with EGFR-mutated advanced lung adenocarcinoma

Abstract

Controversial value of prophylactic cranial irradiation (PCI) in NSCLC in terms of survival benefit prompted us to explore the possible risk factors for brain metastasis (BM) during the course of EGFR-TKIs therapy from EGFR-mutated advanced lung adenocarcinoma and identify the potential population most likely to benefit from PCI, because BM remains a therapeutically challenging issue. We retrospectively reviewed the records of 134 patients with EGFR-mutated advanced lung adenocarcinoma between 2008 and 2012. The cumulative incidence of BM was calculated by the Kaplan-Meier method, and Multivariate Cox regression analysis was used to assess the independent risk factors for BM. Thirty-four patients (34/134, 25.4%) developed BM during the course of EGFR-TKIs therapy. Moreover, the Multivariate analysis indicated that age ≤ 53 years (HR: 2.751, 95 % CI: 1.326-5.707; p = 0.007), serum carcinoembryonic antigen (CEA) ≥ 23 ng/mL (HR: 3.197, 95 % CI: 1.512-6.758; p = 0.002) and EGFR exon 21 point mutations (HR: 2.769, 95 % CI: 1.355-5.659; p= 0.005) were the independent high-risk factors for developing BM, which could offer important insights into the individualized treatment. Further studies are warranted to validate our findings.

Risk Factors of Metachronous Brain Metastasis in Patients with EGFR-Mutated Advanced Non-Small Cell Lung Cancer

“…Furthermore, our results con rmed that the predictive value of gender and KPS score for metachronous BM may remain controversial [35]. Previous studies reported that elevated CEA [20,21,35], NSE [29], and CA125 [29] were independent risk factors of BM. However, there is no correlation between tumor markers levels before treatment (including CEA, NSE, and CA125) and the metachronous BM in our study.…”

“…The factors showing associations (P < 0.100) in the univariable Cox regression analyses, as well as other factors that were reported to be associated with BM in previous studies [20,21] were further examined by multivariable Cox regression analysis. Results of multivariate analysis indicated that age ≤ 49 years (P = 0.035), numbers of extracranial metastases (P = 0.013), and documented malignant pleural effusion (P = 0.002) were independent high-risk factors of developing metachronous BM, while the rst-line treatment regimens and types of EGFR mutations were not associated with metachronous BM in multivariate Cox regression analysis.…”

Risk Factors for Brain Metastases in Patients with Renal Cell Carcinoma

“…Korkmaz et al [11] found that it was easier for patients younger than 65 years to develop hippocampal metastasis. Ma et al [12] identified age ≤ 53 years as a highrisk factor for developing BM in patients with EGFRmutated advanced lung adenocarcinoma. Warren et al [13] found that there was a lower probability of BM in inflammatory breast cancer patients with older age at diagnosis.…”

Risk factors for brain metastases in patients with non–small‐cell lung cancer

“…This result is consistent with the study by Ma. That study revealed that CEA concentrations ≥23 ng/mL ( P = 0.001) were a predictive factor for developing BM after analyzing 134 patients with EGFR‐mutated advanced lung adenocarcinoma …”