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Chen BT, Jin T, Ye N, Chen SW, Rockne RC, Yoon S, Mambetsariev I, Daniel E, Salgia R. Differential Distribution of Brain Metastases from Non-Small Cell Lung Cancer Based on Mutation Status. Brain Sci 2023; 13:1057. [PMID: 37508989 PMCID: PMC10377121 DOI: 10.3390/brainsci13071057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) has a high rate of brain metastasis. The purpose of this study was to assess the differential distribution of brain metastases from primary NSCLC based on mutation status. Brain MRI scans of patients with brain metastases from primary NSCLC were retrospectively analyzed. Brain metastatic tumors were grouped according to mutation status of their primary NSCLC and the neuroimaging features of these brain metastases were analyzed. A total of 110 patients with 1386 brain metastases from primary NSCLC were included in this study. Gray matter density at the tumor center peaked at ~0.6 for all mutations. The median depths of tumors were 7.9 mm, 8.7 mm and 9.1 mm for EGFR, ALK and KRAS mutation groups, respectively (p = 0.044). Brain metastases for the EGFR mutation-positive group were more frequently located in the left cerebellum, left cuneus, left precuneus and right precentral gyrus. In the ALK mutation-positive group, brain metastases were more frequently located in the right middle occipital gyrus, right posterior cingulate, right precuneus, right precentral gyrus and right parietal lobe. In the KRAS mutation-positive patient group, brain metastases were more frequently located in the posterior left cerebellum. Our study showed differential spatial distribution of brain metastases in patients with NSCLC according to their mutation status. Information regarding distribution of brain metastases is clinically relevant as it could be helpful to guide treatment planning for targeted therapy, and for predicting prognosis.
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Affiliation(s)
- Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Taihao Jin
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Ningrong Ye
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Sean W Chen
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
| | - Russell C Rockne
- Division of Mathematical Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Stephanie Yoon
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
| | - Ebenezer Daniel
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
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Advances in the Molecular Landscape of Lung Cancer Brain Metastasis. Cancers (Basel) 2023; 15:cancers15030722. [PMID: 36765679 PMCID: PMC9913505 DOI: 10.3390/cancers15030722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Lung cancer is one of the most frequent tumors that metastasize to the brain. Brain metastasis (BM) is common in advanced cases, being the major cause of patient morbidity and mortality. BMs are thought to arise via the seeding of circulating tumor cells into the brain microvasculature. In brain tissue, the interaction with immune cells promotes a microenvironment favorable to the growth of cancer cells. Despite multimodal treatments and advances in systemic therapies, lung cancer patients still have poor prognoses. Therefore, there is an urgent need to identify the molecular drivers of BM and clinically applicable biomarkers in order to improve disease outcomes and patient survival. The goal of this review is to summarize the current state of knowledge on the mechanisms of the metastatic spread of lung cancer to the brain and how the metastatic spread is influenced by the brain microenvironment, and to elucidate the molecular determinants of brain metastasis regarding the role of genomic and transcriptomic changes, including coding and non-coding RNAs. We also present an overview of the current therapeutics and novel treatment strategies for patients diagnosed with BM from NSCLC.
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Role of Pre-Operative Brain Imaging in Patients with NSCLC Stage I: A Retrospective, Multicenter Analysis. Cancers (Basel) 2022; 14:cancers14102419. [PMID: 35626022 PMCID: PMC9140138 DOI: 10.3390/cancers14102419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/24/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Lung cancer is the worldwide leading cause of cancer-related death among both genders, with about 230,000 patients/year being diagnosed in the US alone. It accounts for about 40% of all brain metastases, which already occur in around 3% of early-stage patients. Nonetheless, current international guidelines do not unanimously recommend brain imaging for use in the early stages of cancer. Some studies have suggested that surgical or radiosurgical treatment of brain metastases may provide better survival, especially in asymptomatic patients. Additionally, advances in genome analysis have identified molecular targets for pharmaceutical agents. These recent advancements in treatment stress the importance of studying incidence as well as patient and tumor characteristics in order to potentially adapt future guidelines and provide the best possible treatment for early-stage lung cancer. This multicentric study analyzed the data of 577 patients diagnosed with early-stage lung cancer who had been submitted for brain imaging at initial tumor staging. Abstract Background: Lung cancer is the worldwide leading oncological cause of death in both genders combined and accounts for around 40–50% of brain metastases in general. In early-stage lung cancer, the incidence of brain metastases is around 3%. Since the early detection of asymptomatic cerebral metastases is of prognostic value, the aim of this study was to analyze the incidence of brain metastases in early-stage lung cancer and identify possible risk factors. Methods: We conducted a retrospective multicentric analysis of patients with Stage I (based on T and N stage only) Non-Small Cell Lung Cancer (NSCLC) who had received preoperative cerebral imaging in the form of contrast-enhanced CT or MRI. Patients with a history of NSCLC, synchronous malignancy, or neurological symptoms were excluded from the study. Analyzed variables were gender, age, tumor histology, cerebral imaging findings, smoking history, and tumor size. Results were expressed as mean with standard deviation or median with range. Results: In total, 577 patients were included in our study. Eight (1.4%) patients were found to have brain metastases in preoperative brain imaging. Tumor histology was adenocarcinoma in all eight cases. Patients were treated with radiotherapy (five), surgical resection (two), or both (one) prior to thoracic surgical treatment. Other than tumor histology, no statistically significant characteristics were found to be predictive of brain metastases. Conclusion: Given the low incidence of brain metastases in patients with clinical Stage I NSCLC, brain imaging in this cohort could be avoided.
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Gao H, He ZY, Du XL, Wang ZG, Xiang L. Machine Learning for the Prediction of Synchronous Organ-Specific Metastasis in Patients With Lung Cancer. Front Oncol 2022; 12:817372. [PMID: 35646679 PMCID: PMC9136456 DOI: 10.3389/fonc.2022.817372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to develop an artificial neural network (ANN) model for predicting synchronous organ-specific metastasis in lung cancer (LC) patients. Methods A total of 62,151 patients who diagnosed as LC without data missing between 2010 and 2015 were identified from Surveillance, Epidemiology, and End Results (SEER) program. The ANN model was trained and tested on an 75/25 split of the dataset. The receiver operating characteristic (ROC) curves, area under the curve (AUC) and sensitivity were used to evaluate and compare the ANN model with the random forest model. Results For distant metastasis in the whole cohort, the ANN model had metrics AUC = 0.759, accuracy = 0.669, sensitivity = 0.906, and specificity = 0.613, which was better than the random forest model. For organ-specific metastasis in the cohort with distant metastasis, the sensitivity in bone metastasis, brain metastasis and liver metastasis were 0.913, 0.906 and 0.925, respectively. The most important variable was separate tumor nodules with 100% importance. The second important variable was visceral pleural invasion for distant metastasis, while histology for organ-specific metastasis. Conclusions Our study developed a “two-step” ANN model for predicting synchronous organ-specific metastasis in LC patients. This ANN model may provide clinicians with more personalized clinical decisions, contribute to rationalize metastasis screening, and reduce the burden on patients and the health care system.
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Affiliation(s)
- Huan Gao
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi-yi He
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing-li Du
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng-gang Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Zheng-gang Wang, ; Li Xiang,
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Zheng-gang Wang, ; Li Xiang,
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Nam JG, Hong H, Choi SH, Park CM, Goo JM, Kim YT, Kim H. No Prognostic Impact of Staging Brain MRI in Patients with Stage IA Non-Small Cell Lung Cancer. Radiology 2022; 303:632-643. [PMID: 35258373 DOI: 10.1148/radiol.212101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Although various guidelines discourage performing brain MRI for staging purposes in asymptomatic patients with clinical stage IA non-small cell lung cancer (NSCLC), evidence regarding their postoperative survival is lacking. Purpose To investigate the survival benefit of performing brain MRI in asymptomatic patients with early-stage NSCLC. Materials and Methods Patients who underwent curative resection between February 2009 and March 2016 for clinical TNM stage T1N0M0 NSCLC were retrospectively included. Patient survival and development of brain metastasis during postoperative surveillance were documented. The cumulative survival rate and incidence of brain metastasis were compared between patients who underwent surgery with or without staging brain MRI by using Cox regression and a Fine-Gray subdistribution hazard model, respectively, for multivariable adjustment. Propensity score matching and inverse probability of treatment weighting were applied for confounder adjustment. Results A total of 628 patients (mean age, 64 years ± 10 [SD]; 319 men) were included, of whom 53% (331 of 628) underwent staging brain MRI. In the multivariable analyses, brain MRI did not show prognostic benefits for brain metastasis-free survival (hazard ratio [HR], 1.06; 95% CI: 0.69, 1.63; P = .79), time to brain metastasis (HR, 1.60; 95% CI: 0.70, 3.94; P = .29), and overall survival (HR, 0.86; 95% CI, 0.54, 1.37; P = .54). Consistent results were obtained after propensity score matching (brain metastasis-free survival [HR, 0.97; 95% CI: 0.60, 1.57; P = .91], time to brain metastasis [HR, 1.29; 95% CI: 0.50, 3.33; P = .60], and overall survival [HR, 0.89; 95% CI: 0.53, 1.51; P = .67]) and inverse probability of treatment weighting. Conclusion No difference was observed between asymptomatic patients with clinical stage IA non-small cell lung cancer who underwent staging brain MRI and those who did not in terms of brain metastasis-free survival, time to brain metastasis, and overall survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Bizzi and Pascuzzo in this issue.
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Affiliation(s)
- Ju G Nam
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyunsook Hong
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Seung Hong Choi
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Chang Min Park
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Jin Mo Goo
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Young Tae Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyungjin Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
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Naresh G, Malik PS, Khurana S, Pushpam D, Sharma V, Yadav M, Jain D, Pathy S. Assessment of Brain Metastasis at Diagnosis in Non-Small-Cell Lung Cancer: A Prospective Observational Study From North India. JCO Glob Oncol 2021; 7:593-601. [PMID: 33891479 PMCID: PMC8162524 DOI: 10.1200/go.20.00629] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The incidence of symptomatic brain metastasis at diagnosis in non–small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC. MATERIALS AND METHODS This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage. RESULTS A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly. CONCLUSION In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.
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Affiliation(s)
- Gundu Naresh
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Khurana
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Yadav
- Department of Radiodiagnosis, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushmita Pathy
- Department of Radiation Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
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Habbous S, Khan Y, Langer DL, Kaan M, Green B, Forster K, Darling G, Holloway CMB. The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada. Ann Thorac Med 2021; 16:81-101. [PMID: 33680129 PMCID: PMC7908893 DOI: 10.4103/atm.atm_283_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS DAP patients were younger (P < 0.0001), had fewer comorbidities (P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76-0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92-1.00]). A longer time until treatment was associated with better overall survival. CONCLUSION DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.
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Affiliation(s)
- Steven Habbous
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yasir Khan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Deanna L Langer
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Melissa Kaan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Bo Green
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Katharina Forster
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Habbous S, Forster K, Darling G, Jerzak K, Holloway CMB, Sahgal A, Das S. Incidence and real-world burden of brain metastases from solid tumors and hematologic malignancies in Ontario: a population-based study. Neurooncol Adv 2021; 3:vdaa178. [PMID: 33585818 PMCID: PMC7872008 DOI: 10.1093/noajnl/vdaa178] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although intracranial metastatic disease (IMD) is a frequent complication of cancer, most cancer registries do not capture these cases. Consequently, a data-gap exists, which thwarts system-level quality improvement efforts. The purpose of this investigation was to determine the real-world burden of IMD. METHODS Patients diagnosed with a non-CNS cancer between 2010 and 2018 were identified from the Ontario Cancer Registry. IMD was identified by scanning hospital administrative databases for cranial irradiation or coding for a secondary brain malignancy (ICD-10 code C793). RESULTS 25,478 of 601,678 (4.2%) patients with a diagnosis of primary cancer were found to have IMD. The median time from primary cancer diagnosis to IMD was 5.2 (0.7, 15.4) months and varied across disease sites, for example, 2.1 months for lung, 7.3 months for kidney, and 22.8 months for breast. Median survival following diagnosis with IMD was 3.7 months. Lung cancer accounted for 60% of all brain metastases, followed by breast cancer (11%) and melanoma (6%). More advanced stage at diagnosis and younger age were associated with a higher likelihood of developing IMD (P < .0001). IMD was also associated with triple-negative breast cancers and ductal histology (P < .001), and with small-cell histology in patients with lung cancer (P < .0001). The annual incidence of IMD was 3,520, translating to 24.2 per 100,000 persons. CONCLUSION IMD represents a significant burden in patients with systemic cancers and is a significant cause of cancer mortality. Our findings support measures to actively capture incidents of brain metastasis in cancer registries.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | - Gail Darling
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Katarzyna Jerzak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sunit Das
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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Huang CS, Hsu PK, Chen CK, Yeh YC, Shih CC, Huang BS. Delayed surgery after histologic or radiologic-diagnosed clinical stage I lung adenocarcinoma. J Thorac Dis 2020; 12:615-625. [PMID: 32274127 PMCID: PMC7139031 DOI: 10.21037/jtd.2019.12.123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The impact of delayed surgery on clinical outcomes after histologic or radiologic diagnosis of clinical stage I adenocarcinoma remains controversial. We evaluated the effects of delayed surgery on outcomes of patients with early-stage lung cancer. Methods Associations between time intervals of “histologic diagnosis-to-surgery” (HDS), “radiologic diagnosis-to-surgery” (RDS), and overall survival in clinical stage I adenocarcinoma were assessed using multivariable Cox proportional hazard analysis. Results A total of 561 consecutive patients with preoperative histologic confirmation of stage I lung cancer between 2006 and 2016 were included. Median time to HDS and RDS were 20 (2–267) and 58 (38–2,983) days. Higher Charlson comorbidity score, receiving brain magnetic resonance imaging screening, and video-assisted thoracoscopic surgery approach were significantly associated with increased risk of late HDS (>21 days). Smaller tumor size and non-radiologic solid-dominant pattern were significantly associated with increased risk of late RDS (>60 days). In the overall cohort, worse 5-year overall survival was associated with late HDS compared to early HDS (75.9% vs. 85.5%, P=0.003). No significant differences were found in later late vs. early RDS (83.7% vs. 83.3%, P=0.570). In 286 propensity-score matched patients, late HDS [adjusted hazard ratio (aHR) =2.031, P=0.038], higher Charlson comorbidity score (aHR=1.610, P=0.023), larger tumor size (aHR=2.164, P=0.031), without brain magnetic resonance imaging screening (aHR=2.051, P=0.045), and tumor with angiolymphatic invasion (aHR=4.638, P=0.001) were significantly associated with lower overall survival. Conclusions In patients with stage I lung adenocarcinoma, delayed surgery after a histologic diagnosis is an independent predictor of overall survival after adjusting for clinical risk factors, suggesting meaningful differences in clinical outcomes between timely vs. delayed surgeries.
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Affiliation(s)
- Chien-Sheng Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Chun-Ku Chen
- Department of Radiology, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Yi-Chen Yeh
- Department of Pathology, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Chun-Che Shih
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Biing-Shiun Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
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