Evaluation of the treatment of non-small cell lung cancer with brain metastasis and the role of risk score as a survival predictor.

Objective: The modality of treatment for patients with brain metastasis from non-small cell lung cancer (NSCLC) has not yet been established. Among these patients, few survive longer than 3 years. However, a small group of these patients demonstrate a better prognosis. The objective of this study is to clarify the efficacy of treatment and evaluate factors affecting long-term patient survival.

Methods: We retrospectively reviewed the medical charts of 70 patients found to have brain metastasis from NSCLC in Fukuoka University Hospital between 1994 and 2002. These patients were grouped according to therapy received for the brain and lung and separated into two groups, as follows: LBR, lung and brain resection; LR, lung resection without brain resection. We also evaluated these groups for a set of several factors. Risk score was calculated with reference to the data from multivariate analysis, which can estimate survival.

Results: The number of patients who underwent lung surgery plus brain surgery was 41. In this LBR, the 1- and 3-year survival rates after treatment of brain were 66.4 and 22.9%, respectively. We found that a therapeutic strategy including surgery for primary lung and brain can afford patients an extended survival time compared to the survivals of other LR group. The 3-year survival of patients with high carcinoembryonic antigen (CEA) was 0 vs. 39.6% among patients normal for CEA. Some factors, including histological type, nodal metastasis, serum LDH and CEA, were associated with survival. The multivariate Cox model identified both adenocarcinoma histological subtype, node status and high serum CEA as independent prognostic factors, whereas serum LDH was not found to be significant. Risk score was determined in our study to estimate prognosis according to the multivariate data. From this equation, previously we can expect 1- or 3-year survival of each patient with brain metastasis from NSCLC, refer to the risk score.

Conclusions: Stringent selection, i.e. low-risk score (adenocarcinoma, node-negative and normal level of CEA) of candidates for surgical treatment for primary lung and brain metastasis from NSCLC may be an acceptable and valuable approach.