Does Initial Staging or Tumor Histology Better Identify Asymptomatic Brain Metastases in Patients with Non–small Cell Lung Cancer?

Abstract

Background: To determine whether the distribution, staging features, or tumor histology of non-small cell lung cancer (NSCLC) distinguishes neurologically symptomatic from asymptomatic patients initially diagnosed with lung cancer, and to determine whether these factors may predict the presence of brain metastasis. Methods: We performed a retrospective review of 809 patients with NSCLC and brain metastases who were treated in our institution between January 1996 and March 2003. Patients who had brain metastasis on initial staging were included. Thoracic computed tomographic scans were reviewed for lung tumor features and staging. Neurological computed tomographic or magnetic resonance image scans were assessed for distribution of brain metastases. Medical records were reviewed for comprehensive staging, tumor histology, and neurological symptoms. Fisher's exact test was used to determine any differences among tumor histology, staging, and imaging features among patients with or without neurological symptoms. Results: Of the 809 patients, 181 had brain metastasis at initial staging. Among these 181 patients, 120 (66%) presented with neurological symptoms (group 1); 61 (34%) patients were asymptomatic (group 2). Patients with adenocarcinoma and large-cell carcinoma had greater odds of brain metastases than patients with squamous cell carcinoma (p ϭ 0.001). There were 106 (58.6%) patients with adenocarcinoma, 32 (17.7%) with large cell carcinoma, and 18 (9.9%) with squamous cell carcinoma. In both groups, most lung cancers were in the right lung with upper lobe dominance. No significant difference in tumor histology or T stage was found between groups, although group 2 was more likely to have a higher N stage. Of the 181 patients with brain metastasis, 60 (33.1%) had N0 disease, 51 (28.2%) had T1 disease, and 23 (19.2%) had no other metastasis. There was no correlation between number/distribution of brain metastases and tumor histology, although patients with disease in the cerebellum or temporal lobes had a greater likelihood of neurological symptoms (odds ratio 3.7). Conclusion:There was no significant difference in tumor histology, staging, or distribution between symptomatic or asymptomatic patients with NSCLC with brain metastases. The odds of brain metastases were greater in those with adenocarcinoma or large-cell carcinoma.

Prophylactic cranial irradiation in non-small cell lung cancer patients: who might be the candidates?

“…30,31 As is the case in the study of Shi et al, the authors of this present study found most of the primary tumors to be located in the right lung and in the upper lobes. 32 These frequent locations of lung tumor did not seem to correlate with the appearance of BM. 32 Central or peripheral location of primary lung tumor was not found to be correlated to BM, which is in agreement with the study of Mujoomdar et al 31 …”

“…Earlier studies correlated the presence of BM with advanced stage, NSCLC histotypes, delay of lung radiotherapy, younger age, and large tumor size. [28][29][30][31][32] However, few studies assessed in this regard tobacco consumption, comorbidities, CT scanner tumor characteristics, or the presence of metastases other than BMs.…”

Ki-67 expression in pulmonary tumors

“…Furthermore, reports show that prophylactic cranial irradiation may be an effective modality for preventing brain metastases in patients with NSCLC treated with adjuvant chemoradiation (28). Despite advances in diagnostic and therapeutic modalities, and sophisticated clinical practice guidelines, it remains unclear whether patients with early stage NSCLC should be screened for brain metastases or not (29)(30)(31). The metastatic cascade is rather complex and involves reciprocal interactions between tumor cells and host tissues, including alterations in tumor cell proliferation, adhesion, proteolysis, invasion, and angiogenesis (32).…”

Antidepressant use and risk of central nervous system metastasis

“…Another study reported motor weakness and convulsion as the most frequent symptoms of brain metastases with almost a quarter of all clinically diagnosed breast cancer cases reporting each of these symptoms [145]. It is important to note that these symptoms occur concurrently in almost 40% of patients [156], although reports of asymptomatic brain metastasis range from 10% of patients to 48% [153,156,157,159].…”