Fadime DEMİR, Ahmet YANARATEŞ, Emine BUDAK

Overall survival and prognostic factors in lung cancer patients with brain metastases

investigate prognostic value of the maximum standardized uptake value (SUVmax) of primary tumor on 18Fluorine-fluorodeoxyglucosepositron emission tomography / computed tomography (18F-FDG PET / CT) FDG PET / CT and other clinicopathological parameters.Material and Methods: Fifty-eight patients with lung cancer who underwent for oncologic purpose and had metastatic lesions in thebrain were included in the study. The location of the primary lung mass and whether other organ metastases presence was evaluatedon the 18F-FDG PET / CT. In axial images, the volume of interest (VOI) was plotted semi-automatically to include lung tumor tissueand SUVmax of the primary lung tumor was measured. Survival analyzes were performed with Kaplan-Meier survival analysis. Theprognostic value of the parameters was evaluated using Cox regression analysis.Results: Of the 58 patients included in the study, 6 (10%) were female and 52 (90%) were male. The mean age was 64.8 ± 9.5years. The mean SUVmax of primary tumor was 10.4 ± 4.5. Median survival was 7 months. Patient age and localization of theprimary tumor were prognostic factors for survival in univariate analysis, whereas sex, SUVmax of primary tumor, presenceof distant metastasis outside the brain, histologic subtype, surgical status of the metastatic brain mass and treatmenttype were not. Overall survival was lower in patients with primary tumor located in the left lung than in the right lung.Conclusion: In conclusion, age and localization of primary tumor are prognostic factors, whereas SUVmax of primary tumor does notappear to be a prognostic factor in lung cancer patients with brain metastases.

PDF

___

1. Torre LA, Bray F, Siegel RL. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
2. Helmut H. Popper. Progression and metastasis of lung cancer. Cancer Metastasis Rev 2016;35:75-91.
3. Goldberg SB, Contessa JN, Omay SB and Chiang V. Lung Cancer Brain Metastases. Cancer J 2015;21: 398-403.
4. Ettinger DS, Wood DE, Aisner DL et al. Non-Small Cell Lung Cancer, Version 5. 2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017;15:504-35.
5. Tsakonas G, De Petris L, Ekman S. Management of brain metastasized non-small cell lung cancer (NSCLC) - From local treatment to new systemic therapies. Cancer Treat Rev 2017;54:122-113.
6. Bae MK, Yu WS, Byun GE et al. Prognostic factors for cases with no extracranial metastasis in whom brain metastasis is detected after resection of non-small cell lung cancer. Lung Cancer 2015;88:195-200.
7. Kanou T, Okami, Tokunaga et al. Prognosis associated with surgery for non-small cell lung cancer and synchronous brain metastasis. Surg Today 2014;44:1321-7.
8. Bernhardt D, Adeberg S, Bozorgmehr F et al. Outcome and prognostic factors in single brain metastases from small-cell lung cancer. Strahlenther Onkol 2018;194:98-106.
9. Lin CH, Hsu KH, Chang SN et al. Increased survival with the combination of stereotactic radiosurgery and gefitinib for non-small cell lung cancer brain metastasis patients: a nationwide study in Taiwan. Radiat Oncol 2015;6:127.
10. Hjorthaug K, Højbjerg JA, Knap MM et al. Accuracy of 18F-FDG PET-CT in triaging lung cancer patients with suspected brain metastases for MRI. Nucl Med Commun. 2015;36:1084-90.
11. Kohutek ZA, Wu AJ, Zhang Z, F et al. FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer. Lung Cancer 2015;89:115-20.
12. Dong M, Liu J, Sun X, et al. Prognositc significance of SUVmax on pretreatment (18) F-FDG PET/CT in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy: a meta-analysis. J Med Imaging Radiat Oncol 2017;61:652-9.
13. Lee JW, Lee SM, Yun M and Cho A. Prognostic Value of Volumetric Parameters on Staging and Posttreatment FDG PET/CT in Patients with Stage IV Non-Small Cell Lung Cancer. Clin Nucl Med 2016;41:347-53.
14. Tas F, Cıftcı R, Kılıç L and Karabulut S. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett. 2013;6:1507-13.
15. Sánchez de Cos J, Sojo González MA, Montero MV et al. Non-small cell lung cancer and silent brain metastasis. Survival and prognostic factors. Lung Cancer 2009;63:140-5.
16. Sun W, Yang X, Liu Y et al. Primary Tumor Location Is a Useful Predictor for Lymph Node Metastasis and Prognosis in Lung Adenocarcinoma. Clin Lung Cancer. 2017;18:49-55.
17. Shaverdian N, Veruttipong D, Wang J et al. Location Matters: Stage I None-Small cell Carcinomas of the Lower Lobes Treated with Stereotactic Body Radiation Therapy Are Associated with Poor Outcomes. Clinical Lung Cancer 2017;12:58-9.
18. Ito M, Yamashita Y, Miyata Y et al. Prognostic impact of the primary tumor location based on the hilar structures in non-small cell lung cancer with mediastinal lymph node metastasis. Lung Cancer 2012;76:93-7.
19. Puri V, Garg N, Engelhardt EE et al. Tumor location is not an independent prognostic factor in early stage non-small cell lung cancer. Ann Thorac Surg. 2010;89:1053-9.
20. Ye WF, Xie X, Yang H et al. Resectable left lower lobe nonsmall cell lung cancer with lymph node metastasis is related to unfavorable outcomes. Chin J Cancer 2016;35:7.