The following is the summary of “Factors for incidence risk and prognosis of synchronous brain metastases in pulmonary large cell carcinoma patients: a population-based study” published in the January 2023 issue of Pulmonary medicine by Zheng, et al.
Synchronous brain metastases (SBM) are common in patients with lung large cell carcinoma (LCC), and these patients have a dismal outlook. The purpose of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) database to assess the predictive and prognostic significance of the clinical parameters of pulmonary LCC patients with SBM at initial diagnosis. From the most recent SEER database (April 2022) researchers were able to identify LCC patients who were diagnosed during the years of 2010 and 2019. Predictive and prognostic indicators for SBM in LCC patients were determined using logistic and Cox regression analyses.
Kaplan-Meier and propensity score matching (PSM) analyses were used to compare the efficacy of various treatments. The study included 1,375 patients with LCC, 216 (15.7%) of whom had SBM at diagnosis. LCC patients treated with SBM had a median overall survival (OS) of 4 months. Multivariate Cox regression found that age 60–79 (95% CI 0.41-0.78; P< 0.001), age 80 (95% CI 0.12-0.45; P<0.001), and bone metastases (1.75; 95% CI 1.22-2.51; P<0.001) were all significant independent predictors of developing SBM. Multivariate Cox regression analysis confirmed that age 60–79, T stage, bone metastases, and treatment were significant predictors of OS.
The best median OS was 15 months in the surgery plus chemotherapy plus radiation therapy group, where all patients were N0 stage and had no further site-specific metastases. SBM was more common in patients diagnosed with LCC who were older than 60 or who had bone metastases. Independent predictive markers for OS of LCC patients with SBM included patient age, T stage, bone metastases, and treatment. When used in conjunction, surgery and chemotherapy/radiation may be the most effective treatment for a small group of patients looking to prolong their lives.