The impact of time interval on prognosis in patients with non-small cell lung cancer brain metastases after metastases surgery: a retrospective study

Abstract

Abstract Purpose Lung cancer is a leading cause of cancer-related deaths worldwide and frequently gives rise to brain metastases (BM), which significantly worsen patient prognosis. This study aimed to identify risk factors associated with overall survival (OS) following non-small cell lung cancer (NSCLC) brain metastases (BM) surgery and to assess the impact of treatment timing on OS. Methods We analyzed data from 74 patients (2011–2021) who underwent BM surgery at our institution. The relationship between various clinical, radiological, and histopathological factors, as well as time intervals (TI) and OS, was examined. Results The median TI was 19 months (range: 9–36 months). Shorter TI < 23 months (aOR 2.87, 95% CI 1.03–8.02, p = 0.045), age ≥ 60 years at BM diagnosis (aOR 2.51, 95%CI 1.07–5.92, p = 0.035), initial M stage of lung cancer as M1 (aOR 2.80, 95%CI 1.04–7.59, p = 0.043), postoperative adjuvant radiotherapy for BM (aOR 0.50, 95%CI 0.25–0.99, p = 0.047), and molecular targeted therapy after BM (aOR 0.15, 95%CI 0.06–0.35, p = 0.015) were independently factors associated with OS after brain metastases surgery. Late-onset BM (TI ≥ 36 months) was observed in 15 cases (20.3%), and it was independently associated with an age at lung cancer diagnosis of ≥ 60 years [adjusted odds ratio (aOR 7.24, 95%CI 1.59–32.95, p = 0.011] ,targeted therapy (aOR 2.27, 95%CI 1.70–3.03, p༜0.001)and absence of adjuvant chemotherapy (aOR 6.46, 95%CI 1.52–27.43, p = 0.011). Conclusions Multiple factors impact the TI between NSCLC and BM. The occurrence of brain metastases (BM) within 23 months after a diagnosis of non-small cell lung cancer (NSCLC) was independently associated with a worse prognosis following BM surgery. In NSCLC patients aged 60 years or older who did not receive adjuvant chemotherapy, there was an increased likelihood of developing brain metastases (BM) after a long progression-free survival period. Additionally, postoperative patients with brain metastases from non-small cell lung cancer should undergo genetic testing to determine the need for targeted molecular therapy. These findings highlight the importance of careful follow-up and consideration of targeted therapy to potentially prolong the survival of these patients.