Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Res Treat. 2022 Jan;54(1):150-156. doi: 10.4143/crt.2021.306. Epub 2021 May 6.
Metachronous brain-only oligorecurrence in patients with non-small cell lung cancer (NSCLC) is a rare event with favorable prognosis, but the clinical outcome has not been fully determined. We retrospectively analyzed clinical outcomes and prognostic factors in metachronous brain-only oligorecurrence in patients with NSCLC who underwent definitive treatment.
We reviewed 4,437 NSCLC patients without oncogenic driver mutations who underwent definitive treatment between 2008 and 2018. Among them, we identified 327 patients who developed 1 to 5 brain metastases with or without systemic metastasis. Of the 327 patients, 71 had metachronous brain-only oligorecurrence without extracranial progression and were treated with local therapy to the brain. Overall survival (OS), progression-free survival (PFS), and prognostic factors affecting OS were analyzed.
The median OS was 38.9 months (95% confidence interval [CI], 21.8 to 56.1 months) in 71 patients. The 2-year OS rate was 67.8% and the 5-year OS rate was 33.1%. The median PFS was 25.5 months (95% CI, 12.2 to 14.4 months). The longest surviving patient had a survival period of 115 months. Through multivariate analysis, Eastern Cooperative Oncology Group ≥ 1 (hazard ratio, 5.33; p=0.005) was associated with poor survival. There was no significant difference in OS between patients with local therapy and those with local plus systemic therapy (18.5 months vs. 34.7 months, p=0.815).
Metachronous brain-only oligorecurrence NSCLC patients who underwent definitive treatment experienced long-term survival with local therapy, highlighting the unique patient population. The role of systemic chemotherapy in this patient population requires further investigation.
非小细胞肺癌（NSCLC）患者发生同时性脑寡转移是一种罕见事件，预后良好，但临床结局尚未完全确定。我们回顾性分析了接受根治性治疗的 NSCLC 患者同时性脑寡转移的临床结局和预后因素。
我们回顾性分析了 2008 年至 2018 年间接受根治性治疗的 4437 例无致癌驱动突变的 NSCLC 患者。其中，我们确定了 327 例 1 至 5 个脑转移灶伴或不伴全身转移的患者。在这 327 例患者中，71 例发生了无颅外进展的异时性脑寡转移，采用局部脑治疗。分析总生存期（OS）、无进展生存期（PFS）和影响 OS 的预后因素。
71 例患者的中位 OS 为 38.9 个月（95%CI，21.8 至 56.1 个月）。2 年 OS 率为 67.8%，5 年 OS 率为 33.1%。中位 PFS 为 25.5 个月（95%CI，12.2 至 14.4 个月）。生存时间最长的患者生存时间为 115 个月。多因素分析显示，东部肿瘤协作组（ECOG）评分≥1（危险比，5.33；p=0.005）与生存不良相关。局部治疗与局部联合全身治疗患者的 OS 无显著差异（18.5 个月比 34.7 个月，p=0.815）。
接受根治性治疗的同时性脑寡转移 NSCLC 患者采用局部治疗可获得长期生存，这突出了这一独特患者群体的特征。全身化疗在这一患者群体中的作用需要进一步研究。
