The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

Abstract

Abstract Purpose: To investigate the prognostic differences between small-cell lung cancer (SCLC) patients with different chemosensitivity to first line chemotherapy who developed brain metastasis as first site of progression. Methods: Patients with brain metastases (BMs) after first-line treatment of SCLC in our hospital admitted from January 2012 to October 2020 were retrospectively analyzed. According to the time interval between the completion of first-line chemotherapy and the onset of BMs (TFI), the patients were divided into chemo-sensitive group (TFI ≥ 90 days, n = 145) and chemo-resistant group (TFI ＜ 90 days, n = 97). Survival time after the onset of brain metastasis (BM-OS), which was calculated from the diagnosis of brain metastases and overall survival (OS), which was calculated from the diagnosis of small-cell lung cancer, were analyzed in this study. Survival curves were plotted using Kaplan-Meier method and differences between groups were compared using the log-rank test. The Chi-square test or Fisher’s exact test was used to compare categorical variables. Results: In total, the median BM-OS and OS were 8.4 months and 18.2 months respectively. The median BM-OS in chemo-sensitive group was 8.8 months and it was 8.0 months in the chemo-resistant group (P = 0.538); and the median OS was 22.0 months and 15.6 months, respectively (P = 0.001). In patients without extracranial progression (n = 193), the median BM-OS in chemo-sensitive and chemo-resistant group were 9.4 months and 9.7 months (P = 0.947), and the median OS were 22.7 months and 16.3 months, respectively (P = 0.017). In patients with extracranial progression (n = 49), the median BM-OS were 5.4 months and 4.2 months (P = 0.161), and the median OS were 17.6 months and 12.3 months, respectively (P = 0.002). Conclusions: After the development of brain metastasis as the first site of progression following chemotherapy in small cell lung cancer, the prognosis of chemo-sensitive patients not necessarily superior to chemo-resistant patients, especially in patients without extracranial progression.