Brain Metastasis in Patients with Small Cell Lung Cancer

Abstract

Purpose To characterize the risk factors for brain metastasis (BM) at presentation and analyze the prognostic factors for patients with small cell lung cancer (SCLC). Patients and Methods Patients were recruited from the SEER database between 2010 and 2016. They were divided into two groups according to BM status. The incidence trends of SCLC and its BM were analyzed by joinpoint software. The risk factors for BM in SCLC were identified by binary logistic regression models. The prognostic factors for SCLC patients with BM were identified by Cox proportional hazard models. Results The incidence of SCLC and its BM significantly decreased after 2010. Totally 11,093 patients were collected, including 1717 (15.5%) patients with BM and 9376 (84.5%) patients without BM. In multivariate logistic regression analysis, age, male and higher T stage were independent risk factors for BM in SCLC patients at presentation. SCLC patients with BM showed inferior survival to those without BM. In multivariate Cox regression analysis, increasing age, large tumor size, and higher N stage were risk factors for poor prognosis, while other race, surgery, adjuvant radiotherapy, and chemotherapy were protective factors for SCLC patients with BM. A nomogram was developed for prognosis evaluation of such patients. Conclusion Age, male and higher T stage were risk factors for BM in SCLC patients at presentation. Increasing age, large tumor size, and advanced N stage may predict poor survival for SCLC patients with BM. Multidisciplinary therapies may provide clinical benefits. This study will help identify patients with higher BM risk and hopefully improve their clinical outcome.

A prognostic nomogram to predict survival in elderly patients with small-cell lung cancer: a large population-based cohort study and external validation

“…These were some unique disease features for elderly SCLC patients. In addition, we identified ten independent prognostic factors for OS and CSS, which were consistent with the previous findings [ 7 , 13 – 16 , 23 – 25 ]. Our model indicated that chemotherapy made the greatest contribution to the prognostic score.…”

“…Our model indicated that chemotherapy made the greatest contribution to the prognostic score. Multiple studies have proved that chemotherapy, as the most important treatment for SCLC, can prolong the survival time of patients [ 7 , 13 , 15 , 23 , 26 ]. Our analysis also indicated that AJCC stage and surgery had greater impacts on patient survival.…”

“…Multiple studies have shown that risk factors such as increased age, male sex and larger tumor are negatively correlated with long-term survival [ 7 , 13 – 15 , 23 , 25 ]. Zhong et al constructed a novel predictive nomogram for extensive-stage SCLC patients by screening out independent prognostic factors such as gender, age, TNM staging and treatment methods [ 15 ].…”

“…Age is an independent prognostic factor for SCLC [ 5 – 7 ]. Previous studies have shown that compared with younger patients, elderly patients are less tolerant to surgery, chemotherapy and radiotherapy, and thus have poorer compliance with anti-tumor therapy and increased side effects [ 6 , 8 ].…”

Safety and efficacy of anlotinib in combination with standard chemotherapy as first-line treatment for extensive-stage small cell lung cancer: A multi-center, prospective study (ACTION-2)

“…These results may be partially a consequence of the fact that more than 90% of patients received 6 cycles of chemotherapy, and 72.1% received subsequent treatment. Additionally, a lower proportion of patients in our study demonstrated brain metastases [12]. A separate study has showed the antitumor activity of anlotinib monotherapy in patients with refractory SCLC.…”