Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 109 Machang Road, Wuhan, 430022, Hubei, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
J Neurooncol. 2023 Sep;164(2):321-330. doi: 10.1007/s11060-023-04426-z. Epub 2023 Aug 30.
The updated Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (lung-molGPA) index provide more accurate survival prediction for patients diagnose with advanced non-small cell lung cancer (NSCLC) with brain metastases (BM). Given that the value of cranial radiotherapy (CRT) is still controversial for NSCLC patients with BM, this retrospective study aimed to evaluate the value of CRT and optimal timing in NSCLC patients with initial BM after stratified with lung-molGPA index.
This study screened NSCLC patients with initial BM in our cancer center from February 2012 to July 2018. The prognosis value of CRT and optimal timing was evaluated with Kaplan-Meier survival analysis and the patients were classified into lung-molGPA0-2 and lung-molGPA2.5-4 group. Upfront CRT was defined as received CRT within 3 months after initial diagnosis and without BM progression, other CRT was classified into deferred CRT.
Overall, 288 patients were enrolled in our study, 156 patients received CRT. The median follow-up time was 47 months. In the entire cohort, the median PFS and OS were 9.2 and 17.0 months, respectively. In the lung-molGPA2.5-4 group, CRT can bring significantly overall survival benefit for NSCLC patients with initial BM (HR: 0.48, 95% CI: 0.34-0.68, P < 0.0001), and the upfront CRT can further expand this survival benefits compared with deferred CRT (HR: 0.49, 95% CI: 0.27-0.89, P = 0.0026). But this phenomenon was not observed in lung-molGPA0-2 group patients.
Upfront CRT could bring significantly overall survival benefit for these patients with lung-molGPA2.5-4 but not for patients with lung-molGPA0-2.
更新的基于分子标志物的肺癌预后分级评估（lung-molGPA）指数为诊断为有脑转移（BM）的晚期非小细胞肺癌（NSCLC）患者提供了更准确的生存预测。鉴于颅放疗（CRT）对有 BM 的 NSCLC 患者的价值仍存在争议，本回顾性研究旨在评估 CRT 的价值和最佳时机，方法是对从 2012 年 2 月至 2018 年 7 月在我们癌症中心诊断为初始 BM 的 NSCLC 患者进行分层，根据 lung-molGPA 指数评估 CRT 和最佳时机的预后价值。
本研究共纳入 288 例初始 BM 的 NSCLC 患者，其中 156 例接受 CRT。采用 Kaplan-Meier 生存分析评估 CRT 和最佳时机的预后价值，并将患者分为 lung-molGPA0-2 和 lung-molGPA2.5-4 组。在 lung-molGPA2.5-4 组中，CRT 可为 NSCLC 有初始 BM 的患者带来显著的总生存获益（HR：0.48，95%CI：0.34-0.68，P<0.0001），而 upfront CRT 可进一步扩大这一生存获益，与 deferred CRT 相比（HR：0.49，95%CI：0.27-0.89，P=0.0026）。但在 lung-molGPA0-2 组患者中未观察到这一现象。
upfront CRT 可为 lung-molGPA2.5-4 患者带来显著的总生存获益，但对 lung-molGPA0-2 患者则不然。
