Non-small cell lung cancer with synchronous brain metastases: Identification of prognostic factors in a retrospective multicenter study (HOT 1701)

Abstract Background Non-small-cell lung cancer (NSCLC) is associated with a high incidence of brain metastasis (BM), and the prognosis of patients with NSCLC and BM is poor. This study aimed to identify the prognostic factors and elucidate the survival rates of Japanese patients with NSCLC and BM at initial diagnosis. Methods HOT 1701 is a retrospective multicenter study of patients with NSCLC and BM at initial diagnosis. The medical records of all consecutive patients diagnosed with advanced or recurrent NSCLC and BM at 14 institutions of the Hokkaido Lung Cancer Clinical Study Group Trial (HOT) in Japan were reviewed. The participants were categorized based on the presence or absence of driver mutations. The Kaplan–Meier method was used to estimate median overall survival (OS). Univariate and multivariate analyses were performed to identify prognostic factors in these patients. Results Among 566 patients with NSCLC and BM, the median OS was 11.8 months. Patients with driver mutations survived longer than those without driver mutations. The univariate and multivariate analyses revealed 6 independent prognostic factors: age ≥65 years, poor performance status, T factor, absence of driver gene mutations, presence of extracranial metastases, and number of BM. According to the prognostic score based on these 6 factors, the patients were stratified into 3 risk groups: low-, intermediate-, and high-risk, with median OS of 27.8, 12.2, and 2.8 months, respectively. Conclusions We developed a new prognostic model for patients with NSCLC and BM, which may help determine prognosis at diagnosis. Lay Summary Non-small-cell lung cancer (NSCLC) is a very aggressive type of lung cancer that often spreads to the brain. The authors of this study wanted to better understand which factors determine how long a patient lives once NSLC metastasizes to the brain. To do this, the authors reviewed the medical records of 566 patients in Japan with metastases in their brains from NSCLC. Their results showed that, on average, patients lived for 11.8 months. They identified 6 factors that affected how long they lived. These factors included age, overall health status, the severity of the original lung cancer, genetic differences in the cancer, whether the cancer had spread to other parts of the body, and the total number of different metastases in the brain. Based on these factors, the authors identified 3 groups of patients, with those in the high-risk group having much shorter surviv