Neurological symptom burden impacts survival prognosis in patients with newly diagnosed non-small cell lung cancer brain metastases.
neurological assessment
neurological symptoms
prognostic factors in brain metastases
survival prognosis in symptomatic brain metastases
symptomatic burden
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
09
03
2020
revised:
24
05
2020
accepted:
02
06
2020
pubmed:
18
7
2020
medline:
12
6
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM. Patients with newly diagnosed BM from non-small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM. A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis-specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33-1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23-1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM. Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non-small cell lung cancer. Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real-life cohort of patients with BM from non-small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non-small cell lung cancer.
Sections du résumé
BACKGROUND
Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM.
METHODS
Patients with newly diagnosed BM from non-small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM.
RESULTS
A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis-specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33-1.50 [P < .001]), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23-1.57 [P < .001]) was found to be independently associated with survival prognosis from the time of diagnosis of BM.
CONCLUSIONS
Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non-small cell lung cancer.
LAY SUMMARY
Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM). The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real-life cohort of patients with BM from non-small cell lung cancer. In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis. The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non-small cell lung cancer.
Identifiants
pubmed: 32678971
doi: 10.1002/cncr.33085
pmc: PMC7540353
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4341-4352Subventions
Organisme : Daiichi Sankyo Company
ID : UE71101084
Informations de copyright
© 2020 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.
Références
Oncologist. 2014 Jul;19(7):751-9
pubmed: 24899645
Eur J Cancer. 2012 Dec;48(18):3439-47
pubmed: 22883982
J Clin Oncol. 2002 Apr 15;20(8):2076-84
pubmed: 11956268
Neurocrit Care. 2017 Sep;27(Suppl 1):82-88
pubmed: 28913634
J Intensive Care Med. 2017 Jan;32(1):15-24
pubmed: 26647408
J Clin Oncol. 2012 Feb 1;30(4):419-25
pubmed: 22203767
Lancet Oncol. 2012 May;13(5):459-65
pubmed: 22456429
ESMO Open. 2016 Mar 16;1(2):e000024
pubmed: 27843591
Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):655-61
pubmed: 19942357
Lancet Neurol. 2004 Mar;3(3):159-68
pubmed: 14980531
Neuro Oncol. 2017 May 1;19(5):625-635
pubmed: 28453751
Clin Exp Metastasis. 2013 Apr;30(4):357-68
pubmed: 23076770
Neuro Oncol. 2017 Feb 1;19(2):162-174
pubmed: 28391295
Cancer. 2020 Oct 1;126(19):4341-4352
pubmed: 32678971
Curr Oncol. 2016 Jun;23(3):e239-47
pubmed: 27330360
J Clin Oncol. 2018 Aug 28;:JCO2018783118
pubmed: 30153097
Lancet Oncol. 2017 Jul;18(7):863-873
pubmed: 28592387
J Thorac Oncol. 2008 Feb;3(2):140-4
pubmed: 18303434
Int J Mol Sci. 2013 Apr 24;14(5):8708-18
pubmed: 23615466
Ugeskr Laeger. 2002 Jul 1;164(27):3522-6
pubmed: 12116679
J Neurooncol. 2016 Jan;126(2):347-54
pubmed: 26547911
Neuro Oncol. 2017 May 1;19(5):603-604
pubmed: 28453752
Neuro Oncol. 2013 Nov;15(11):1568-79
pubmed: 24049111
Neurology. 1993 Sep;43(9):1678-83
pubmed: 8414011
Lancet Oncol. 2016 Jul;17(7):984-993
pubmed: 27283860
Lancet Oncol. 2016 Jul;17(7):976-983
pubmed: 27267608
ESMO Open. 2018 Jan 26;3(1):e000262
pubmed: 29387475