Abstract:

ObjectiveTo analyze the prognosis-related factors of patients with surgical treatment of lung cancer brain metastases.MethodsFrom January 2016 to November 2018, the clinical data of the patients with lung cancer brain metastases received surgical treatment in Department of Neurosurgery, Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively collected, and completed data of 83 patients were obtained. The single factor analysis was based on the log-rank method, and the multi-factor analysis was used by the Cox proportional hazard model, and the R software was used to map the influencing factors into the nomogram and verify them.ResultsThe median overall survival (OS) of 83 patients was 27.0 months. The median OS of patients with surgery alone was 15.7 months, the median OS of patients with surgery combined with radiotherapy, chemotherapy or targeted therapy was 27.7 months, and the difference was statistically significant (χ²=8.735,P=0.003). The results of single factor analysis showed that gender (χ²=4.652,P=0.031), smoking history (χ²=8.239,P=0.004), postoperative targeted treatment (χ²=13.697,P<0.001), postoperative adjuvant therapy (χ²=8.735,P=0.003), pathology of metastatic tumor (χ²=11.799,P=0.001), and lung cancer molecular graded prognostic assessment (Lung-molGPA) sore (χ²=11.333,P=0.004) affected patients' OS. The results of multivariate analysis showed that smoking history (HR=0.311, 95%CI: 0.107-0.901,P=0.031), postoperative targeted therapy (HR=3.563, 95%CI: 1.286-9.868,P=0.015), pathology of metastatic tumor (HR=0.364, 95%CI: 0.137-0.965,P=0.042), Lung-molGPA score (HR=0.595, 95%CI: 0.374-0.946,P=0.028) were independent prognostic factors for OS of patients with lung cancer brain metastases. In order to further evaluate the prognosis of patients, nomogram was drawn using these four independent prognostic factors. The model had high accuracy and could better evaluate the prognosis of patients.ConclusionLung cancer brain metastases patients with operative indication can benefit from surgery, and active adjuvant therapy after operation can further prolong the OS of patients. The nomogram constructed by smoking, targeted therapy, pathology of metastatic tumor and Lung-molGPA score can be used to evaluate individual patient outcomes and guide clinical treatment.

Key words:Lung neoplasms,Neurosurgical procedures,Prognosis,Nomogram,Brain metastases