Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer.
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.
['Ouyang|Wen|W|', 'Yu|Jing|J|', 'Zhou|Yan|Y|', 'Hu|Jing|J|', 'Huang|Zhao|Z|', 'Zhang|Junhong|J|', 'Xie|Conghua|C|http://orcid.org/0000-0003-2836-6373']
D000178:Acrylamides D000230:Adenocarcinoma D000328:Adult D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000814:Aniline Compounds D000970:Antineoplastic Agents D001932:Brain Neoplasms D002289:Carcinoma, Non-Small-Cell Lung D016371:Cranial Irradiation D066246:ErbB Receptors D005260:Female D006801:Humans D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009154:Mutation D011379:Prognosis D047428:Protein Kinase Inhibitors D012189:Retrospective Studies D012307:Risk Factors
Risk factor Non-small cell lung cancer Brain metastases Epidermal growth factor receptor