Martín-Abreu Carla, García-Gil María, Méndez-Monge Margarita, Fariña-Jerónimo Helga, Plata-Bello Julio
Department of Medical Oncology, Hospital Universitario de Canarias, 38320 La Laguna, Spain.
Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, 38320 La Laguna, Spain.
Cancers (Basel). 2025 Jun 20;17(13):2059. doi: 10.3390/cancers17132059.
Brain metastases are a common and devastating complication of non-small cell lung cancer (NSCLC), severely affecting prognosis and quality of life. Despite increasing interest in the role of platelets in tumor progression and dissemination, the potential impact of antiplatelet therapy on brain metastasis in NSCLC remains underexplored.
In this retrospective observational study, we analyzed data from 650 patients diagnosed with NSCLC over a four-year period to evaluate whether prior or subsequent exposure to antiplatelet agents correlates with a reduced incidence of brain metastases.
Patients exposed to antiplatelet therapy, predominantly aspirin, presented with more comorbidities and were generally older. Despite these differences, they showed a significantly lower risk of developing brain metastases during the disease course (6.9% vs. 20.0%, < 0.001), particularly among those with advanced-stage disease at diagnosis. A longer time to metastasis development was also observed in antiplatelet users (77.5 vs. 62.6 months, < 0.001), along with improved progression-free survival. Additionally, patients on antiplatelets before diagnosis had a lower probability of presenting brain metastases at the time of diagnosis (3.9% vs. 12.1%, = 0.014), and no cases of brain metastases occurred in patients who started antiplatelet therapy shortly after diagnosis. These findings highlight the potential of antiplatelet agents to interfere with key mechanisms of metastatic spread, including immune evasion and premetastatic niche formation.
Importantly, this study provides one of the first real-world analyses suggesting a consistent and stage-dependent association between antiplatelet use and reduced brain metastatic burden in NSCLC. By bridging the gap between preclinical insights and clinical outcomes, our work offers a novel and clinically relevant perspective that supports further research into the integration of antiplatelet therapy in NSCLC management.
脑转移是非小细胞肺癌（NSCLC）常见且严重的并发症，严重影响预后和生活质量。尽管血小板在肿瘤进展和扩散中的作用日益受到关注，但抗血小板治疗对NSCLC脑转移的潜在影响仍未得到充分研究。
在这项回顾性观察研究中，我们分析了650例在四年期间被诊断为NSCLC的患者的数据，以评估之前或之后使用抗血小板药物是否与脑转移发生率降低相关。
接受抗血小板治疗的患者，主要是使用阿司匹林的患者，合并症更多，且普遍年龄较大。尽管存在这些差异，但他们在疾病过程中发生脑转移的风险显著较低（6.9%对20.0%，<0.001），尤其是在诊断时处于晚期疾病的患者中。抗血小板药物使用者发生转移的时间也更长（77.5个月对62.6个月，<0.001），无进展生存期也有所改善。此外，诊断前使用抗血小板药物的患者在诊断时出现脑转移的概率较低（3.9%对12.1%，=0.014），诊断后不久开始抗血小板治疗的患者未发生脑转移病例。这些发现突出了抗血小板药物干扰转移扩散关键机制的潜力，包括免疫逃逸和转移前生态位形成。
重要的是，本研究提供了首批真实世界分析之一，表明抗血小板药物的使用与NSCLC脑转移负担减轻之间存在一致且与分期相关的关联。通过弥合临床前见解与临床结果之间的差距，并提供一个新的、具有临床相关性的观点，支持进一步研究将抗血小板治疗纳入NSCLC管理中。
