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Identification of predictors for brain metastasis in newly diagnosed non-small cell lung cancer: a single-center cohort study

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify clinical and staging chest CT characteristics predictive of brain metastasis in patients with newly diagnosed NSCLC dichotomized according to resectability.

Methods

Patients newly diagnosed with NSCLC of clinical stages II–IV between November 2017 and October 2018 were enrolled and classified into resectable (stage II+IIIA) and unresectable stages (stage IIIB/C+IV) according to chest CT. Associations of clinicopathological characteristics and CT findings with brain metastasis were analyzed using logistic regression. Predictive models were evaluated using receiver operating characteristics curve analysis. A subgroup analysis for unresectable-stage patients with known epidermal growth factor receptor gene (EGFR) mutation status was performed.

Results

This study included 911 NSCLC patients (mean age, 65 ± 11 years; 620 men), 194 of whom were diagnosed with brain metastasis. For resectable stages, independent predictors for brain metastasis were N2-stage (13 of 25 patients), absence of air-bronchogram/bubble lucency (23 of 25 patients), and presence of spiculation (15 of 25 patients), with a model combining the two imaging features showing an AUC of 0.723. In unresectable stages, independent predictors of brain metastasis were younger age, female sex, extrathoracic metastasis, and adenocarcinoma, with models combining these showing AUCs of 0.675–0.766. In the subgroup with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis, with the model showing AUCs of 0.641–0.732.

Conclusion

CT-derived imaging features, clinical stages, lung cancer subtype, and EGFR mutation were associated with brain metastasis in patients with newly diagnosed NSCLC. The predictors were completely different between resectable and unresectable stages.

Key Points

• In resectable stages of NSCLC, two imaging features (absence of air-bronchogram/bubble lucency and presence of spiculation) and N2 stage were independent predictors of brain metastasis.

• In unresectable stages of NSCLC, younger age, female sex, extrathoracic metastasis, and adenocarcinoma were associated with brain metastasis.

• In the subgroup of NSCLC with known EGFR-mutation status, extrathoracic metastasis and positive EGFR mutation were independent predictors of brain metastasis.

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Abbreviations

AJCC:

American Joint Committee on Cancer

ALK:

Anaplastic lymphoma kinase gene

CI:

Confidence interval

EGFR:

Epidermal growth factor receptor gene

NSCLC:

Non-small cell lung cancer

OR:

Odds ratio

ROC:

Receiver operating characteristics

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Acknowledgements

We are grateful to Jungbok Lee, who is a statistician in our institution, for help with statistical modeling.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea

    Sohee Park, Sang Min Lee, Yura Ahn, Minjae Kim, Chong Hyun Suh, Kyung-Hyun Do & Joon Beom Seo

Authors
  1. Sohee Park
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  2. Sang Min Lee
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  3. Yura Ahn
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  4. Minjae Kim
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Corresponding author

Correspondence to Sang Min Lee.

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Guarantor

The scientific guarantor of this publication is Sang Min Lee.

Conflict of Interest

The authors declare no competing interests.

Statistics and Biometry

Jungbok Lee, who is a statistician in Asan Medical Center, helped with statistical modeling.

Informed Consent

Written informed consent was waived by the Institutional Review Board.

Ethical Approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

All of our study patients (911 out of 911) were reported in a previous retrospective study, which evaluated the diagnostic yield of brain MRI in the initial evaluation of non-small cell lung cancer (reference 14, Diagnostic Yield of Staging Brain MRI in Patients with Newly Diagnosed Non–Small Cell Lung Cancer. Radiology 297419-427).

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Park, S., Lee, S.M., Ahn, Y. et al. Identification of predictors for brain metastasis in newly diagnosed non-small cell lung cancer: a single-center cohort study. Eur Radiol 32, 990–1001 (2022). https://doi.org/10.1007/s00330-021-08215-y

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  • DOI: https://doi.org/10.1007/s00330-021-08215-y

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