Randjelovic Nevena, Petronijevic Marina, Calamac Marina, Peulic Marija, Filipovic Biljana, Mutavdzic Vladan, Djuric Aleksandar, Rankovic Teodora, Bugarcic Milos, Canak Ivana, Mikov Jelena, Igrutinovic Nebojsa, Novak Stela, Marjanovic Marko, Perovic Jelena, Urosevic Teodora, Cufer Tanja
Department of Medical Oncology, University Clinical Centre of Kragujevac, 34000 Kragujevac, Serbia.
Daily Hospital Care, Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia.
Cancers (Basel). 2025 May 9;17(10):1603. doi: 10.3390/cancers17101603.
Real-world data provide insights into populations underrepresented in clinical trials such as non-small-cell cancer (NSCLC) patients with brain metastases (BMs). Despite global survival improvement due to novel drug employment, their impact in resource-limited settings like Serbia remains underexplored. This study analyzes the overall survival (OS) of NSCLC patients with BMs treated in routine clinical practice, considering patient-, disease- and treatment-related factors amid restricted access to novel drugs.
We retrospectively analyzed 267 NSCLC patients diagnosed with BMs from 2018 to 2022 at a single Serbian clinical center. Inclusion required histologically confirmed NSCLC, radiologically verified BMs and complete clinical data. OS was defined as the time from BM verification to death or last follow-up. Kaplan-Meier curves and Cox regression were used for survival analysis.
Median OS (mOS) was 5.0 months. Univariate analysis linked age < 65 years, female gender, single BM, asymptomatic BMs, ECOG PS 0-1, BM verification at diagnosis and combined systemic and local therapy to better OS. Combined therapy offered the best survival rates (mOS: 9.0 months), while best supportive care and local-only therapy both resulted in a poor mOS of 2.0 months. Immunotherapy and targeted therapy were associated with the highest mOS, outperforming chemotherapy alone (13.0 vs. 7.0 months, < 0.001). Multivariate analysis confirmed younger age, single BM, early BM verification and combined therapy as independent predictors of improved survival.
limited access to novel therapies remains associated with poor patient survival, highlighting the need for better global availability.
真实世界数据为临床试验中代表性不足的人群提供了见解，例如伴有脑转移（BM）的非小细胞肺癌（NSCLC）患者。尽管新型药物的应用使总体生存率有所提高，但它们在塞尔维亚等资源有限的环境中的影响仍未得到充分探索。本研究分析了在常规临床实践中接受治疗的伴有BM的NSCLC患者的总生存期（OS），同时考虑了在新型药物获取受限的情况下与患者、疾病和治疗相关的因素。
我们回顾性分析了2018年至2022年在塞尔维亚一个临床中心诊断为BM的267例NSCLC患者。纳入标准要求组织学确诊为NSCLC、放射学证实为BM且临床数据完整。OS定义为从BM确诊到死亡或最后一次随访的时间。采用Kaplan-Meier曲线和Cox回归进行生存分析。
中位总生存期（mOS）为5.0个月。单因素分析表明，年龄<65岁、女性、单个BM、无症状BM、东部肿瘤协作组（ECOG）体能状态0-1、诊断时BM确诊以及全身联合局部治疗与更好的OS相关。联合治疗的生存率最高（mOS：9.0个月），而最佳支持治疗和单纯局部治疗的mOS均较差，为2.0个月。免疫治疗和靶向治疗的mOS最高，优于单纯化疗（13.0对7.0个月，P<0.001）。多因素分析证实，年龄较小、单个BM、早期BM确诊和联合治疗是生存改善的独立预测因素。
新型疗法的可及性有限仍然与患者生存率低相关，这凸显了提高全球可及性的必要性
