Improved Survival With Surgical Treatment of Primary Lung Lesions in Non-Small Cell Lung Cancer With Brain Metastases: A Propensity‐Matched Analysis of Surveillance, Epidemiology, and End Results Database

Abstract

ObjectivesNon-small cell lung cancer (NSCLC) with Brain metastases (BM) is an advanced disease with poor prognosis and low survival rate. Our study evaluated the survival benefit of primary lung resection with mediastinal lymph node dissection in NSCLC patients with BM using Surveillance, Epidemiology, and End-result (SEER) databases.MethodsAll cases analyzed were from Surveillance, Epidemiology, and End Results database. The data of the patients with BM of NSCLC from 2010 to 2016 was retrospectively analyzed. Patients (N=203) patients who underwent radical surgical treatment for primary lung lesions and patients (N=15500) who did not undergo surgery were compared. We successfully analyzed patients using propensity score matching (PSM). Kaplan‐Meier and Cox‐ regression analyses were applied to assess prognosis.ResultsThe median survival in the surgery group was longer than in the control group (27 months vs 5 months; P < 0.001) in the overall sample, 21 months longer compared to the control group (27 months vs 6 months; P<0.001) in a PSM cohort. Cox regression analysis showed that underwent surgery patients in the propensity-matched sample had a significantly lower risk of mortality (HR:0.243, 95%CI: 0.162-0.365, P < 0.001) compared with untreated patients. Multivariate analysis identified the following as independent risk factors for NSCLC with BM: no primary resection surgery, age >65 years, worse differentiation, squamous cell carcinoma, lymphatic metastasis, no systemic therapy. Subgroup analysis revealed that radical resection of the primary lung provided a survival benefit regardless of marital status, tumor size, tumor grade, tumor T stage, and mediastinal lymph node metastasis after PSM.ConclusionRadical resection of primary lung can improve the survival of NSCLC patients with BM. Male, age>65years, poorly differentiated tumor, tumor size>5cm, and mediastinal lymph node metastasis were factors for poor survival.

Brain metastasis from non-small cell lung cancer: management and prognosis of primary lung tumor resection

“…Patients aged younger with less comorbidities and well-supported socioeconomically are more likely to tolerate aggressive local treatment to both primary lung lesions and BM, and thus might warrant better survival. [15,25] When narrowing down the study population to those who received primary lung tumor resection, similar results were indicated as mentioned above (Table 3).…”

“…In a retrospective study, the data of 203 NSCLC patients with BM who received primary pneumonectomy plus mediastinal lymphadenectomy and a 1:2 matching control group were extracted from the SEER database. [15] Propensity scoring match (PSM) was applied to minimize selection bias. It is suggested that patients who get thoracic surgery had a better median survival time than those without thoracic surgery in the control group (27 months, 95%CI 19.3-34.7 vs 6 months 95%CI 4.4-7.6).…”

Overexpression of TWF1 promotes lung adenocarcinoma progression and is associated with poor prognosis in cancer patients through the MMP1 signaling pathway

“…Lung cancer is the leading cause of cancer-related death globally, and LUAD is the most common subtype ( 13 ). The popularization of spiral chest computed tomography (CT) has facilitated the diagnosis of patients with early-stage lung cancer ( 5 , 14 ). Nevertheless, because of the insidious onset of lung cancer, many patients already have mid-/late-stage cancers when they are diagnosed, thereby missing the optimal surgical timing, or requiring persistent anti-tumor therapy postoperatively.…”

“…Due to the insidious onset, LUAD patients are commonly diagnosed at an advanced stage, resulting in loss of the opportunity for surgical treatment. The introduction of targeted therapy and immunotherapy has greatly improved the survival outcomes of patients with advanced LUAD ( 5 , 6 ). Hence, searching for more biomarkers of LUAD is of great significance.…”

The Role of Microglia in Brain Metastases: Mechanisms and Strategies

“…Lung cancer, breast cancer, and melanoma have been reported to have a higher risk of brain metastases than other types of cancers [ 1 - 3 ]. Brain metastases develop in 30%-50% of patients with non-small cell lung cancer (NSCLC), which severely affect their overall survival [ 4 ]. An increasing number of patients with breast cancer develop brain metastases, especially those with HER2-positive or triple-negative tumors [ 5 ].…”