Department of Respiratory Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan.
Int J Clin Oncol. 2018 Aug;23(4):641-646. doi: 10.1007/s10147-018-1254-y. Epub 2018 Feb 26.
Japanese Lung Cancer Society and ESMO guideline recommends screening for brain metastasis in all patients with non-small cell lung cancer (NSCLC), while NCCN/ACCP guidelines do not recommend screening patients who are asymptomatic and with clinical stage I NSCLC. However, brain metastasis sometimes occurs in early stage NSCLC patients without any neurological symptoms.
We retrospectively reviewed medical records of 124 patients admitted to the University of Tokyo Hospital with stage IV NSCLC from January 2012 to April 2016. We analyzed clinical stage, the presence of the central nervous system manifestations and the number of brain metastases.
Forty-six out of 124 cases had brain metastasis at presentation. The brain metastasis group had larger number of female, never smokers and patients with EGFR mutation compared with extracranial metastasis group. Twenty-one of 35 adenocarcinoma cases with brain metastasis had EGFR mutations. Out of 46 brain metastasis patients, 29 patients (63%) were asymptomatic and patients with EGFR mutations were significantly less likely to have neurological symptoms (4/21 vs. 7/14, p = 0.049). Six out of 46 cases with brain metastasis (13%) were clinical T1-2aN0. In clinical T1-2aN0 cases, only one patient had neurological symptoms at presentation.
In clinical T1-2aN0 lung cancer patients with brain metastasis, almost all patients were asymptomatic. Patients with EGFR mutations and brain metastasis were likely to be asymptomatic. Regardless of central nervous system symptoms, routine brain imaging seems warranted in all NSCLC patients, especially in areas where patients have a higher frequency of EGFR mutations.
日本肺癌学会和 ESMO 指南建议所有非小细胞肺癌（NSCLC）患者都进行脑转移筛查，而 NCCN/ACCP 指南则不建议对无症状且临床分期为 I 期的 NSCLC 患者进行筛查。然而，脑转移有时也会发生在没有任何神经症状的早期 NSCLC 患者中。
我们回顾性分析了 2012 年 1 月至 2016 年 4 月期间在东京大学医院就诊的 124 例 IV 期 NSCLC 患者的病历。我们分析了临床分期、中枢神经系统表现和脑转移灶数量。
124 例患者中有 46 例在就诊时出现脑转移。脑转移组中女性、从不吸烟者和 EGFR 突变患者的比例高于颅外转移组。35 例腺癌脑转移患者中有 21 例存在 EGFR 突变。46 例脑转移患者中，29 例（63%）无症状，且 EGFR 突变患者出现神经症状的可能性显著降低（4/21 比 7/14，p=0.049）。46 例脑转移患者中，有 6 例（13%）为临床 T1-2aN0。在临床 T1-2aN0 病例中，只有 1 例患者有神经症状。
在临床 T1-2aN0 伴脑转移的 NSCLC 患者中，几乎所有患者都无症状。存在 EGFR 突变和脑转移的患者更可能无症状。无论是否有中枢神经系统症状，常规脑成像似乎都适用于所有 NSCLC 患者，尤其是在 EGFR 突变频率较高的地区。
