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

An, Ning; Wang, Jing; Wang, Haoyi; Li, Ji; Liu, Yang; Yu, Jinming; Zhu, Hui

doi:10.1002/cam4.1865

Cited by 47 publications

(50 citation statements)

References 89 publications

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“…Furthermore, our results confirmed 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.…”

Section: Discussionsupporting

confidence: 84%

Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer

Ouyang

Zhou

et al. 2020

BMC Cancer

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Background: NSCLC patients with EGFR mutation were at a higher incidence of developing brain metastasis (BM). Patients with BM are associated with high mortality. Reducing BM incidence becomes increasingly significant for NSCLC patients to achieve prolonged survival. The aim of the study was to explore the possible risk factors of developing metachronous BM during EGFR-TKIs treatment, and to identify the potential candidates for prophylactic cranial irradiation (PCI) or the first-line Osimertinib treatment. Methods: A total of 157 consecutive EGFR-mutated advanced NSCLC patients without BM at initial diagnosis in our institution from 2012 and 2018 were retrospectively reviewed. Comparisons of OS were performed based on BM status. The cumulative incidence of metachronous BM was calculated by the Kaplan-Meier method, and the independent risk factors of metachronous BM were investigated by multivariate analysis. Results: Patients developing metachronous BM had worse survival (mOS: 22.1 months) than patients notdeveloping BM (mOS: 44.8 months). Moreover, the multivariate analysis indicated that age ≤ 49 years (P = 0.035), number of extracranial metastases (P = 0.013), and malignant pleural effusion (P = 0.002) were independent risk factors of metachronous BM. Furthermore, the 1-year actuarial incidence of developing metachronous BM in patients with no risk factor (n = 101), 1 risk factor (n = 46), and 2 risk factors (n = 10) were 7.01, 14.61, and 43.75%, respectively (P < 0.001). Conclusions: Patients developing metachronous BM during EGFR-TKIs treatment have worse outcomes. Our results suggested that EGFR-mutated advanced NSCLC patients with ≥1 risk factors were candidates for PCI or the first-line Osimertinib treatment.

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Section: Discussionsupporting

confidence: 84%

Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer

Ouyang

Zhou

et al. 2020

BMC Cancer

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“…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.…”

Section: Discussionsupporting

confidence: 71%

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

Ouyang

Zhou

et al. 2020

Preprint

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Background NSCLC patients with EGFR mutation were at a higher incidence of developing brain metastasis (BM). Patients with BM are associated with high mortality. Reducing BM incidence becomes increasingly significant for NSCLC patients to achieve prolonged survival. The aim of the study was to explore the possible risk factors of developing metachronous BM during EGFR-TKIs treatment, and to identify the potential candidates for prophylactic cranial irradiation (PCI ) or the first-line osimertinib treatment. Methods A total of 157 consecutive EGFR-mutated advanced NSCLC patients without BM at initial diagnosis in our institution from 2012 and 2018 were retrospectively reviewed . Comparisons of OS were performed based on BM status. The cumulative incidence of metachronous BM was calculated by the Kaplan-Meier method, and the independent risk factors of metachronous BM were investigated by multivariate analysis. Results Patients developing metachronous BM had worse survival (mOS: 22.1 months) than patients not-developing BM (mOS: 44.8 months). Moreover, the multivariate analysis indicated that age ≤ 49 years ( P =0.035), number of extracranial metastases ( P =0.013), and malignant pleural effusion ( P =0.002) were independent risk factors of metachronous BM. Furthermore, the 1-year actuarial incidence of developing metachronous BM in patients with no risk factor (n =101), 1 risk factor (n =46), and 2 risk factors (n =10) were 7.01%, 14.61%, and 43.75%, respectively ( P <0.001). Conclusions Patients developing metachronous BM during EGFR-TKIs treatment have worse outcomes. Our results suggested that EGFR-mutated advanced NSCLC patients with ≥ 1 risk factors were candidates for PCI or the first-line Osimertinib treatment.

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“…[27][28][29][30] However, our results regarding age distribution and metastatic spread are in line with others since we also found that brain metastases appeared more frequently in the younger population and bone metastases among elderly patients. [30][31][32] A possible explanation might be that brain metastases are associated with the angiogenic microenvironment, and the cerebrovascular microenvironment factors of young patients may be better than those of older patients, while in the case of bone metastases the more favorable bone marrow microenvironment for metastatic spread and the higher incidence of osteoporosis in elderly patients might contribute to the higher incidence of bone metastases. 31,33,34 Next, we focused on the longitudinal changes of the measured CBC parameters during cancer progression and metastatic spread, and found significant changes with regard to all parameters in the experimental group.…”

Section: Discussionmentioning

confidence: 99%

“…[30][31][32] A possible explanation might be that brain metastases are associated with the angiogenic microenvironment, and the cerebrovascular microenvironment factors of young patients may be better than those of older patients, while in the case of bone metastases the more favorable bone marrow microenvironment for metastatic spread and the higher incidence of osteoporosis in elderly patients might contribute to the higher incidence of bone metastases. 31,33,34 Next, we focused on the longitudinal changes of the measured CBC parameters during cancer progression and metastatic spread, and found significant changes with regard to all parameters in the experimental group. According to the longitudinal analysis, we found significantly decreasing ALC in all patient subgroups irrespective of histopathological and metastatic types.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal analysis of complete blood count parameters in advanced‐stage lung cancer patients

et al. 2020

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Background Metastatic lung cancer is a debilitating disease, but with the advances in immunotherapy, therapeutic options have vastly increased. Numerous complete blood count parameters (CBC) have been described as easily accessible biomarkers that might predict response to immunotherapy. However, to date, no comprehensive study has been performed on the longitudinal changes of these parameters during cancer progression. Methods The clinicopathological variables and CBC parameters of 986 advanced stage lung cancer patients were retrospectively analyzed. Blood tests were performed as part of the routine checkup and the results were recorded at the time of the diagnosis of the primary tumor, the diagnosis of brain or bone metastases, and also during the last available follow‐up. Results In the experimental subcohort, 352 and 466 patients were diagnosed with brain and bone metastases, respectively. The control group consisted of 168 patients without clinically detectable or other distant organ metastases. In our longitudinal analyses, we found significantly decreasing absolute lymphocyte count (ALC: P < 0.001), and significantly increasing absolute neutrophil count (ANC: P < 0.001) levels in all patient subgroups, irrespective of histopathological type and metastatic site. Interestingly, patients with brain metastases had significantly descending‐ascending platelet count (PLT) trendlines ( P < 0.001), while the bone metastatic subgroup exhibited significantly ascending‐descending trendlines ( P = 0.043). Conclusions Significantly decreasing ALC, significantly increasing ANC and fluctuating PLT levels may be found in brain and bone metastatic lung cancer patients during disease progression. Our findings might contribute to improve personalized healthcare in this devastating malignancy. Key points Significant findings of the study Significantly decreasing ALC, and significantly increasing ANC levels can be found in advanced‐stage lung cancer patients during disease progression Patients with brain metastases have descending‐ascending PLT trendlines, while patients with bone metastases exhibit ascending‐descending trendlines during disease progression What this study adds The descending values for ALC, and the ascending mean values for PLT and ANC, might be suggestive of poor response to second‐ or third‐line immunotherapy in advanced‐stage lung cancer patients. The current study might help to improve patient selection and treatment strategies for brain and/or bone metastatic lung cancer patients.

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

Cited by 47 publications

References 89 publications

Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer

Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer

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

Longitudinal analysis of complete blood count parameters in advanced‐stage lung cancer patients

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