Pichert Matthew D, Canavan Maureen E, Maduka Richard C, Li Andrew X, Ermer Theresa, Zhan Peter L, Kaminski Michael, Udelsman Brooks V, Blasberg Justin D, Mase Vincent J, Dhanasopon Andrew P, Boffa Daniel J
Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
JTO Clin Res Rep. 2022 Apr 6;3(5):100318. doi: 10.1016/j.jtocrr.2022.100318. eCollection 2022 May.
Available guidelines are inconsistent as to whether patients with newly diagnosed clinical stage II NSCLC should receive routine brain imaging.
The National Cancer Database was queried for the prevalence of isolated brain metastases among patients with newly diagnosed NSCLC in 2016 and 2017. Patients with metastases in locations other than the brain were excluded. The prevalences were then stratified by clinical T and N classifications and further stratified into a summary stage, which was calculated based on T and N classifications. The summary stage represents the clinical stage that would have been available at the time of decision for brain imaging.
A total of 6,949 of 149,958 patients (4.6%) with clinical stages I, II, III, or brain-limited stage IV NSCLC had dissemination limited to the brain. As T and N stages increased, prevalence of brain metastases generally increased. Among patients with node-negative (N0) NSCLC, the prevalence of brain-only metastases increased from 1.2% in patients with T1a to 3.8% among patients with T4 ( < 0.001). Among patients with T1a, the prevalence of brain-only metastases increased from 1.2% for patients with N0 to 7.9% for patients with N3 ( < 0.001). The prevalence of brain-limited metastases generally increased with increasing summary stage. The prevalence of brain-only metastases among patients with stage IA was 1.7% whereas that among patients with stage IIIA was 6.7% ( < 0.001). Of note, the prevalence of brain-limited metastases was approximately 6% for both summary stages II and III.
Considering the similarity in prevalence of isolated brain metastases and the potential hazards associated with brain imaging in early stage NSCLC, practitioners may consider a more liberal use of brain imaging when interpreting conflicting guidelines.
对于新诊断的临床II期非小细胞肺癌（NSCLC）患者是否应接受常规脑成像检查，现有指南并不一致。
查询国家癌症数据库，以获取2016年和2017年新诊断的NSCLC患者中孤立性脑转移的患病率。排除脑外其他部位有转移的患者。然后根据临床T和N分类对患病率进行分层，并进一步分层为一个汇总分期，该分期是根据T和N分类计算得出的。汇总分期代表在决定是否进行脑成像检查时本应有的临床分期。
在149,958例临床I期、II期、III期或脑局限IV期NSCLC患者中，共有6,949例（4.6%）的转移局限于脑。随着T和N分期增加，脑转移的患病率总体上升。在淋巴结阴性（N0）的NSCLC患者中，仅脑转移的患病率从T1a患者的1.2%增至T4患者的3.8%（<0.001）。在T1a患者中，仅脑转移的患病率从N0患者的1.2%增至N3患者的7.9%（<0.001）。脑局限转移的患病率通常随着汇总分期增加而上升。IA期患者中仅脑转移的患病率为1.7%，而IIIA期患者中为6.7%（<0.001）。值得注意的是，汇总分期II和III的脑局限转移患病率均约为6%。
考虑到孤立性脑转移患病率的相似性以及早期NSCLC脑成像检查相关的潜在风险，临床医生在解读相互矛盾的指南时，可考虑更灵活地使用脑成像检查。
