Evaluation of the Effect of Lymph Node Status on the Survival of Non-Small Cell Lung Cancer Patients With Brain Metastases: Applications of a Novel Grade Prognostic Assessment Score Model Involving N Stage

Abstract

Background: Grade prognostic assessment (GPA) is widely used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). This study aimed to investigate whether lymph node status (LNS) could be included as one of the GPA variables for NSCLC with BMs. Methods: Overall, 586 patients with NSCLC and BMs were retrospectively analyzed. Overall survival stratified by LNS was analyzed using the Kaplan-Meier method. Multivariate analysis was also performed to identify independent prognostic factors using the Cox proportional hazards progression model. In the updated GPA index, prognostic factors and criteria of GPA score were weighted by effect magnitude relative risk (RR) and statistical significance. Results: In NSCLC patients with BMs, those with lymph node involvement had worse overall survival (mOS, 13.4 months vs. 25.9 months, P <0.001) than those without lymph node involvement. Multivariate analysis showed that LNS might be an independent prognostic factor (RR: 1.702, CI: 1.340-2.162, P <0.001). Finally, five prognostic factors including LNS, the age of the patient, Karnofsky performance status (KPS), the number of BMs, and extracranial metastases were enrolled in our novel GPA index. With the updated GPA index involving the N stage, survival analysis was also performed. Prognostic results were significantly different among these four subgroups (Class A vs.

Prognostic value of thoracic tumor staging and volume parameters in non-small cell lung cancer patients with synchronous solitary bone metastasis

“…This study showed that patients in group I who received aggressive treatment (primary tumor surgical resection and metastatic disease surgery and/or combined chemoradiotherapy) achieved long-term survival. This is consistent with many retrospective studies on stage IV lung cancer with oligometastasis (21)(22)(23)(24)(25). Although there was no statistically significant difference in OS between group I and group II in the multivariate analysis, there was a significant clinical difference (44 vs. 28 months; 39.6% vs. 21.3%).…”

Heterogeneity in intracranial relapses after complete resection of lung adenocarcinoma: Distinct features of brain‐only relapse versus synchronous extracranial relapse

“…It has been recognized that the prognosis of cancer patients with brain metastases is affected by the status and the number of synchronous extracranial metastases(ECM), 28,29 and even the status of lymph node metastases 30 . However, which group of patients might develop brain oligometastases remained a problem.…”

“…It has been recognized that the prognosis of cancer patients with brain metastases is affected by the status and the number of synchronous extracranial metastases(ECM), 28 , 29 and even the status of lymph node metastases. 30 However, which group of patients might develop brain oligometastases remained a problem. In order to explore the distinct features of early‐stage lung adenocarcinoma patients who developed brain oligometastases, we compared brain‐only relapse (oligometastases) group with brain‐with relapse (synchronous ECM) group.…”

Integrative lymph node-mimicking models created with biomaterials and computational tools to study the immune system

“…Third, the integrative framework can be a useful clinical tool for personalized medicine. For instance, data from lymphatic bioimaging and patient information can be fed into artificial intelligence system and risk-scoring classification computational models to predict high-risk groups of cancer recurrence of LN metastasis [ [314] , [315] , [316] ]. By developing biochips with patient-derived biological materials, combinatorial drugs can be identified to treat cancer metastasis involving LNs.…”