The actuarial incidence of brain metastases in 975 patients undergoing surgery for early-stage lung cancer.
8094 Background: The risk of developing brain metastases after definitive treatment for locally-advanced non-small cell lung cancer (NSCLC) is approximately 30%-50%. The risk for patients with early-stage disease is less defined. We sought to investigate this further and study potential factors associated with an increased risk. METHODS: The records of all patients who underwent surgery for T1-2 N0-1 NSCLC at Duke University between 1995-2005 were reviewed. Patients who received preoperative therapy, had synchronous primaries, or had a prior history of lung cancer were excluded. The cumulative incidence of distant metastases and brain metastases was estimated using the Kaplan-Meier method. A univariate and multivariate analysis assessed factors associated with the development of brain metastases. RESULTS: Of 975 consecutive patients, 85% were stage I and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5-year actuarial rate of distant metastases and brain metastases was 31% (95% CI: 27-35%) and 10% (95% CI: 8-13%), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (HR 1.03), larger tumor size (HR 1.26), lymphovascular space invasion (HR 1.87), and lymph node involvement (HR 1.18) were associated with an increased risk of brain metastases. CONCLUSIONS: In this large series of patients treated surgically for early-stage NSCLC, the 5-year actuarial risk of brain metastases was 10%. While prophylactic cranial irradiation is currently under investigation in locally-advanced disease, a better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early-stage NSCLC who are at particularly high risk. No significant financial relationships to disclose.
Boyd, JA; Hubbs, JL; Hollis, DR; Kirkpatrick, JP; Kim, DW; Marks, LB; Kelsey, CR
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