Factors for incidence risk and prognosis of synchronous brain metastases in pulmonary large cell carcinoma patients: a population-based study

Abstract

Background Patients with pulmonary large cell carcinoma (LCC) have a high incidence of synchronous brain metastases (SBM) and a poor prognosis. Our study was to evaluate the predictive and prognostic value of the clinical characteristics of pulmonary LCC patients with SBM at initial diagnosis by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Methods LCC patients, diagnosed from 2010 to 2019, were identified from the latest SEER database which was released in April 2022. Logistic regression and Cox regression were used to identify the predictive and prognostic factors for LCC patients with SBM. Propensity score matching (PSM) and Kaplan–Meier analyses were applied to assess different therapy modalities. Results A total of 1375 LCC patients were enrolled in this study and 216 (15.7%) of them had SBM at the initial diagnosis. The median overall survival (OS) of LCC patients with SBM was 4 months. Multivariate Cox regression identified age 60–79 (OR 0.57; 95% CI 0.41–0.78; p < 0.001), age ≥ 80 (OR 0.23; 95% CI 0.12–0.45; p < 0.001) and bone metastases (OR 1.75; 95% CI 1.22–2.51; p < 0.001) as significant independent predictors for developing SBM. Multivariable Cox regression revealed that age 60–79, T stage, bone metastases and chemotherapy were independent prognostic factor for OS. The surgery combined with chemotherapy and radiotherapy group, in which all patients were N0 stage and had no other site-specific metastases, exhibited the best median OS of 15 months. Conclusions LCC patients with age < 60 or bone metastases were more likely to have SBM at initial diagnosis. Age, T stage, bone metastases and chemotherapy were independent prognostic factors for OS of LCC patients with SBM. Highly selected patients might achieve the best survival benefit from surgery combined with chemotherapy and radiotherapy.

Efficacy of Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost (SIB-WBRT) for brain metastases

“…The occurrence of radionecrosis was not observed in any of the patients, indicating that SIB-WBRT is safe and reliable. And after further analysis, it was found that the number of brain metastases in patients before treatment might be an independent prognostic factor for iPFS (13,14).…”

Exploration of radiotherapy strategy for brain metastasis patients with driver gene positivity in lung cancer

“…The targeted-first therapy and radiotherapy-first treatment sequences have not been shown to significantly differ in terms of patient survival outcomes. Recent studies have demonstrated that there is no significant difference in patient survival between the targeted-first therapy and radiotherapy-first treatment sequences in patients with EGFR mutation-positive lung cancer brain metastases [16][17][18]. A clinical study conducted by Ke et al in 2018 observed 10 patients in the targeted therapy alone group who received targeted therapy first and then received radiotherapy as salvage therapy for failed metastasis control, and 10 patients in the radiotherapy alone group who received radiotherapy first.…”