Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer

-

English
10 pages
Obtenez un accès à la bibliothèque pour le consulter en ligne
En savoir plus

Description

Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset. Methods Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan–Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM. Results Fifty-three (24.4 %) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86–9.19; P = 0.001) and the ratio of metastatic to examined nodes or lymph node ratio (LNR) ≥ 30 % (RR: 3.33, 95 % CI: 1.79–6.18; P = 0.000) were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %. Conclusions In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.

Sujets

Informations

Publié par
Publié le 01 janvier 2012
Nombre de lectures 20
Langue English
Signaler un problème
Dinget al. Radiation Oncology2012,7:119 http://www.rojournal.com/content/7/1/119
R E S E A R C HOpen Access Risk factors of brain metastases in completely resected pathological stage IIIAN2 nonsmall cell lung cancer 1 1,31 11 11 1 Xiao Ding , Honghai Dai, Zhouguang Hui , Wei Ji , Jun Liang , Jima Lv , Zongmei Zhou , Weibo Yin , 2 1* Jie Heand Luhua Wang
Abstract Background:Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset. Methods:Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the KaplanMeier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM. Results:Fifty-three (24.4%) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95% CI: 1.869.19; P= 0.001)and the ratio of metastatic to examined nodes or lymph node ratio (LNR)% CI: 1.79(RR: 3.33, 9530 %were found to be6.18; P= 0.000) associated with an increased risk of BM. In patients with non-squamous cell cancer and LNRthe 5-year30 %, actuarial risk of BM was 57.3%. Conclusions:In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNRare at30 % the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients. Keywords:Non-small cell lung cancer, Brain metastases, Prophylactic cranial irradiation, Risk factors, Non-squamous cell cancer, Lymph node ratio
Background Nonsmall cell lung cancer (NSCLC) comprises approxi mately 85% of lung cancer. Locally advanced (LA) NSCLC comprises approximately 31of NSCLC.44 % The risk of developing brain metastases (BM) in patients with early stage NSCLC is 10%.[1] However, the risk of BM after treatment for LANSCLC is much higher, ap proximately 30BM is a devastating issue with50 %.[16] a striking impact on survival and quality of life.
* Correspondence: wlhwq@yahoo.com 1 Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Pan jia yuan nan li 17#, Chao yang District, Beijing 10021, China Full list of author information is available at the end of the article
Advances in surgical and radiation techniques have diminished locoregional relapse of LANSCLC. Systemic chemotherapy has reduced the risk of extracranial me tastases. Combinedmodality therapy significantly in creases survival. Recent studies employing multimodality therapy have reported median survival ranging from 20 to 43 months and 3year survival rates of 34for63 % LANSCLC.[713] However, chemotherapy has limited impact on BM because drugs do not easily penetrate the bloodbrain barrier (BBB), which leaves the brain rela tively undertreated.[5,14,15] The risk of BM increases as survival improves. Several studies have demonstrated that longer survival for patients with LANSCLC is
© 2012 Ding et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.