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Q. Zhang
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-029 - Risk Factors of Brain Metastases in Completely Resected Stage IIIA(N2) Non-Small Cell Lung Cancer (ID 1513)
09:30 - 09:30 | Author(s): Q. Zhang
- Abstract
Background:
As the first failure, the rate of distant failure was much higher than local failure in patients with completely resected stage IIIA(N2) NSCLC . Brain was the most common site of distant failure as the first failure, and more than 90% Brain metastases (BM) developed in 3 years.We aimed to identify the risk factors of BM as the initial site of failure in 3 years and to define the highest-risk patients who are most likely to benefit from prophylactic cranial irradiation (PCI).
Methods:
The medical records of 301 consecutive patients with pathological stage IIIA (N2) NSCLC who underwent complete surgery were reviewed between January 2005 and July 2012. We observed the correlation between clinical, pathological, microenvironmental factors and BM to find out the risk factors of BM. Main outcome measure was BM as the first site of failure in 3 years. The cumulative incidence of BM as the first site of failure were determined using the Kaplan–Meier analyiss. To assess the risk factors of BM as the first site of failure in 3 years, the log-rank test was used for univariate analysis, and Cox regression was used for multivariate analysis.
Results:
The 1-, 2-, and 3-year risks for patients developing BM as the initial site of failure were 9.3%，17.7% and 25.8%, respectively. Univariate analysis showed that adenocarcinomas (P = 0.000), multiple N2 stations (P = 0.025), multiple regions of mediastinal lymph node (MLN) involvement (P = 0.023), and highest MLN metastasis (P=0.023) were significantly associated with an increased risk of developing BM as the first site of failure in 3 years. Patients with the tumor budding >5 experienced increased BM in 3 years versus patients with the tumor budding ≤5 (P=0.068) Multivariate analysis showed that adenocarcinomas and multiple N2 stations were significantly associated with the high risk of BM as the initial site of failure in 3 years. In patients with adenocarcinomas and multiple N2 stations, the 3-year actuarial risk of BM as the initial failure was 43.5%. Figure 1
Conclusion:
In patients with completely resected stage IIIA (N2) NSCLC, adenocarcinomas and multiple N2 stations were independent risk factors of BM as the initial failure in 3 years. Patients with the tumor budding >5 had a tendency to experience more BM. Patients with adenocarcinomas and multiple N2 stations are at the highest risk of BM, and are most likely to benefit from PCI.
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-028 - Risk Factors of Brain Metastases in Completely Resected Stage IIIA(N2) Pulmonary Adenocarcinomas (ID 2369)
09:30 - 09:30 | Author(s): Q. Zhang
- Abstract
Background:
Previous studies show that adenocarcinomas is the main high risk factor of brain metastases (BM) in NSCLC, and 90% of BM developes in 3 years. In patients with completely resected stage IIIA(N2) pulmonary adenocarcinomas, we aimed to identify the risk factors of BM as the first site of failure in 3 years on the basis of the new lung adenocarcinoma classification and molecular biology information.
Methods:
Patients with IIIA(N2) pulmonary adenocarcinomas, who had undergone radical surgery in our hospital from January 2005 to July 2012 were retrospectively reviewed. We observed the correlation among clinical factors, the new lung adenocarcinoma classification, lymph node status, microenvironmental factors, gene mutation status and BM to find out the risk factors of BM. DNA of EGFR and KRAS was extracted and purified from primary tumors embedded in paraffin blocks. KRAS and EGFR mutation analyses were performed by using DNA sequencing. Main outcome measure was BM as the first site of failure in 3 years.The cumulative incidence of BM as the first site of failure were determined using the Kaplan–Meier analyiss. The log-rank test was used for univariate analysis, and Cox regression was used for multivariate analysis.
Results:
179 patients with completely resected stage IIIA(N2) pulmonary adenocarcinomas were included in this study. EGFR and KRAS mutations were found in tumors 41.3% and 11.7%, respectively. The most common EGFR mutations were deletions in exon 19 and the p.L858R point mutation in exon 21. The most common KRAS mutations were G-T or G-C point mutation in codon 12. Brain was the most common site of distant failure as the first failure, and 93.3% BM developed in 3 years after the complete resection. Multivariate analysis showed that the extra-capsular extension（ECE）, cN2 and KRAS mutations were significantly associated with the high risk of BM as the initial site of failure in 3 years, while EGFR 19 exon mutations were the low risk of BM. The risk of BM in patients with KRAS mutations were significantly higher than patients with EGFR 19 exon mutations or other EGFR mutaions (P=0.018). Figure 1
Conclusion:
In patients with completely resected stage IIIA(N2) pulmonary adenocarcinomas, ECE, cN2 and KRAS mutations were independent high risk factors for BM as the initial failure in 3 years. The EGFR 19 exon mutation may be a protective factor of BM. The new lung adenocarcinoma classification and tumor microenvironment were not statistically significant factors in our series.
