Non-Small Cell Lung Cancer Patients with Brain Metastases and Limited Access to Systemic Therapy

OBJECTIVE:We aimed to identify prognostic factors associated with overall survival in patients with brain metastases from non-small cell lung cancer (BM-NSCLC) who had limited access to systemic therapy. MATERIAL AND METHODS:We retrospectively analyzed 83 patients with BM-NSCLC.Data collected included age, sex, performance status, histology, neurologic symptoms, extracranial metastasis (ECM), and receipt of whole-brain radiotherapy (WBRT) and systemic treatment.Associations between these factors and time to death were assessed using Cox proportional hazards regression analysis. RESULTS:The mean age of the patients was 63.1±8.9 years.Approximately 30% of patients had ECM, whereas 14% received systemic treatment.Three-quarters of the cohort underwent WBRT.The median survival time was 2.7 months [95% confidence interval (CI): 2.2-4.1 months].The 6-month and 1-year survival probabilities were 26.5% (95% CI: 17.6%-36.3%)and 9.6% (95% CI: 4.5%-17.1%),respectively.Multivariable analysis demonstrated that ECM was significantly associated with an increased risk of death [adjusted hazard ratio (aHR): 4.22, 95% CI: 1.27-14.0,P = 0.019, for newly diagnosed lung cancer; aHR: 6.33, 95% CI: 1.62-24.79,P = 0.008, for controlled primary lung cancer with ECM; and aHR: 11.32, 95% CI: 2.89-56.1,P = 0.003, for uncontrolled primary lung cancer and ECM].Receipt of systemic treatment was significantly associated with a lower risk of death (aHR: 0.39, 95% CI: 0.18-0.80,P = 0.011).WBRT was not significantly associated with improved survival (aHR: 0.79, 95% CI: 0.43-1.44,P = 0.441). CONCLUSION:The presence of ECM and the absence of systemic treatment were significantly associated with shorter survival in patients with BM-NSCLC.