Risk of brain metastases in patients with nonmetastatic lung cancer: Analysis of the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) data

Abstract

Background Brain metastases (BM) remain an important cause of morbidity and mortality in lung cancer patients. Our study evaluated population-based incidence and outcomes of BM in patients with non-metastatic lung cancer. Methods Patients diagnosed with non-metastatic first primary lung cancer, between 1973–2011, in the Metropolitan Detroit Surveillance Epidemiology and End Results (SEER) registry were used for analysis. Age-adjusted Odds Ratios (OR) of developing BM based on various demographic characteristics and histology were calculated with 95% confidence intervals (CIs). Adjusted Cox Proportional Hazards Ratios and Log Rank Tests of Kaplan-Meier Survival Curves were calculated to evaluate survival differences for non-small cell (NSCLC) and small cell lung cancers (SCLC). Results The incidence of BM in non-metastatic NSCLC and SCLC was 9% and 18% respectively. There was variation in the incidence of BM according to NCSLC histology. Incidence of BM was higher in patients < 60 years old in both NSCLC and SCLC, but there were no differences by race for either histological group. Female patients with NSCLC were more likely to have BM than males. There was variation in proportion of BM in both NSCLC and SCLC patients over the three 13-year of diagnosis periods. Risk of death (hazard ratio, HR) was significantly higher for those with BM in NSCLCs, but not significantly higher in SCLC. Conclusions The incidence of BM in non-metastatic lung cancer patients varies according to histology, age, and sex. BM are associated with worse survival for NSCLC but not SCLC.

Should we screen for brain metastases in non‐small cell lung cancer?

“…This is similar to the 1.3% detection rate of asymptomatic brain metastases on MRI reported in a Canadian study of operable NSCLC patients . Higher incidences of 7.8–9% are reported from cancer registries . However, these data are historical, in an era where brain MRI and PET CT would not have been routine.…”

“…6 Higher incidences of 7.8-9% are reported from cancer registries. 7,8 However, these data are historical, in an era where brain MRI and PET CT would not have been routine. In addition the registry data do not differentiate between neurologically symptomatic and asymptomatic patients.…”

Brain metastasis in lung cancer: Building a molecular and systems-level understanding to improve outcomes

“…The phenomenon of lung cancer metastasis to the brain is not a new one; it has long been noted that lung tumors have a predilection to spread to and within the central nervous system (Goldberg et al, 2015; Wang et al, 2009; Schouten et al, 2002; Goncalves et al, 2016). However, as imaging modalities have improved and as clinicians have worked to anticipate the spread of disseminated lung cancer to the brain, the instance of lung cancer metastasis in the brain has increased dramatically in recent decades.…”

“…Other studies have attempted to predict the risk of brain metastasis in the setting of previously non-metastatic disease. One of the largest studies to do this, analyzing historical data from 1973 to 2011 using the SEER database revealed a 9% risk of patients with previously non-metastatic NSCLC developing brain metastasis over the course of their disease, while 18% of small cell lung cancer patients without previous metastasis went on to develop brain metastasis as their disease progressed (Goncalves et al, 2016). The reasons underlying this predilection for the central nervous system, as well as the recent increase in the frequency of brain metastasis identified in patients remain important questions for both clinicians and basic scientists.…”

Icotinib is as efficacious as gefitinib for brain metastasis of EGFR mutated non-small-cell lung cancer

“…The median overall survival (OS) of patients with brain metastases without any treatment was no more than 3 months [5]. The therapeutic methods for brain metastases of NSCLC were very limited and the treatment outcomes are relatively poor [6].…”