Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico.
Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología, Mexico City, 14080, Mexico.
Lung Cancer. 2021 May;155:183-190. doi: 10.1016/j.lungcan.2021.01.023. Epub 2021 Jan 27.
Brain metastases (BM) are frequent among lung cancer patients, affecting prognosis and quality of life. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) lung adenocarcinoma (LADC) classification (IASLC/ATS/ERS) has prognostic impact in early-stage disease; however, its role in the advanced setting is not precise. This study aims to determine the correlation between the predominant histological subtype and the risk of developing brain metastases (BM) in locally advanced and metastatic (stages IIIB-IV) LADC.
A total of 710 patients with LADC were treated at our institution from January 2010 to December 2017. After excluding patients with brain metastases at diagnoses (n = 151), they were categorized according to the IASLC/ATS/ERS LADC classification to estimate the risk of developing brain metastases. A competing risk analysis was employed, considering death a competing risk event.
From 559 patients, the mean age was 59 ± 13.2 years, women (52.4 %), and clinical-stage IV (79.2 %). LADC subtypes distribution was lepidic (11.6 %), acinar (37.9 %), papillary (10.2 %), micropapillary (6.8 %), and solid (33.5 %). A total of 27.0 % of patients developed BM, 32.9 % died without brain affection, and 40.0 % did not progress. The predominantly solid subtype showed the greatest probability of all subtypes for developing BM [HR 4.0; 95 % CI (1.80-8.91), p = 0.0006], followed by micropapillary [HR1.11; 95 % CI (0.36-3.39), p = 0.85). The solid subtype, moderately differentiated tumors, age, and ECOG PS (>2) were associated with increased hazards in the multivariate analysis.
According to the IASLC/ATS/ERS classification, the predominantly solid pattern was significantly associated with an increased risk of developing BM in patients with locally advanced and metastatic LADC. Its prognostic value might help explore novel clinical approaches, modify monitoring for earlier detection, prevent complications, and reduce morbidity.
脑转移（BM）在肺癌患者中很常见，影响预后和生活质量。国际肺癌研究协会（IASLC）、美国胸科学会（ATS）和欧洲呼吸学会（ERS）肺腺癌（LADC）分类（IASLC/ATS/ERS）对早期疾病有预后影响；然而，其在晚期的作用并不明确。本研究旨在确定局部晚期和转移性（IIIb-IV 期）LADC 中主要组织学亚型与发生脑转移（BM）风险之间的相关性。
我们机构于 2010 年 1 月至 2017 年 12 月共收治 710 例 LADC 患者。排除初诊时存在脑转移的患者（n=151）后，根据 IASLC/ATS/ERS LADC 分类进行分组，以评估发生脑转移的风险。考虑死亡为竞争风险事件，采用竞争风险分析。
559 例患者中，平均年龄为 59±13.2 岁，女性占 52.4%，临床分期为 IV 期（79.2%）。LADC 亚型分布为贴壁型（11.6%）、腺泡型（37.9%）、乳头型（10.2%）、微乳头型（6.8%）和实体型（33.5%）。共有 27.0%的患者发生 BM，32.9%的患者死亡但无脑转移，40.0%的患者未进展。主要为实体型的亚型发生 BM 的概率明显高于其他所有亚型[HR 4.0；95%CI（1.80-8.91），p=0.0006]，其次是微乳头型[HR 1.11；95%CI（0.36-3.39），p=0.85]。多变量分析显示，实体型亚型、中分化肿瘤、年龄和 ECOG PS（>2）与危险度增加相关。
根据 IASLC/ATS/ERS 分类，局部晚期和转移性 LADC 患者中主要为实体型模式与发生 BM 的风险增加显著相关。其预后价值可能有助于探索新的临床方法，修改监测方案以早期发现，预防并发症，降低发病率。
