MMAP-18 ASSOCIATION BETWEEN BRAIN METASTASES AND IMMUNOSUPPRESSION IN LUNG CANCER - A RETROSPECTIVE COHORT STUDY

Abstract Lung cancer carries substantial morbidity and mortality worldwide. The impact of immunosuppression on these outcomes remains underexplored. We used the National Inpatient Sample database to retrospectively identify lung cancer patients hospitalized across the United States in 2022. Multivariate logistic regression using STATA BE was performed to find an association between brain metastases (Bmets), mortality, and immunosuppression. Patients with Bmets were younger than those without Bmets (66.5 vs 70.6 years, p<0.001) and as a result, insurance coverage for Medicaid was higher in the Bmets group while Medicare coverage was higher in the non-Bmets group. Bmets patients were treated more frequently in large (56% vs 51%, p<0.001), teaching (81% vs 76%, p<0.001) hospitals reflecting the complexity of care required for these patients. Lung cancer patients with hypogammaglobulinemia (OR 1.11, CI 0.51-2.38), chronic steroid (OR 1.10, CI 0.98-1.23) and immunosuppressant (OR 1.22, CI 0.29-5.23) use, Human Immunodeficiency Virus (HIV) infection (OR 1.19, CI 0.64-2.21) were more likely to have Bmets, however this was not statistically significant. Lung cancer patients with end-stage renal disease (ESRD) (OR 0.67, CI 0.49-0.92), liver disease (OR 0.75, CI 0.65-0.87), and heart failure (OR 0.70, CI 0.64-0.77) were less likely to have Bmets possibly because they succumbed to their comorbidities before their cancer metastasized. Neutropenia (OR 1.20, CI 1.01-1.42), protein energy malnutrition (OR 1.21, CI 1.14-1.30), ESRD (OR 1.37, CI 1.10-1.71), and heart failure (OR 1.36, CI 1.26-1.47) were associated with significantly higher inpatient mortality. Immunosuppression and medical co-morbidities impact the incidence and outcomes of brain metastases in lung cancer. Further research is required to explore this association.