Neurologic Deficits Shorten Overall Survival in NSCLC With Brain Metastases at Diagnosis

Patients who present with neurologic symptoms associated with newly diagnosed non-small cell lung cancer (NSCLC) brain metastases may need closer monitoring and further evaluation for prognostic assessment, according to study findings presented at the ESMO Congress 2019 in Barcelona, Spain.

Researchers investigated the impact of neurologic symptom burden on mortality rates in patients with NSCLC brain metastases and found that the presence of neurologic symptoms was independently associated with a shorter survival.

The diagnosis-specific graded prognostic assessment (DS-GPA) score is used to stratify common primary tumor metastases to the brain into subgroups. The researchers conducted a multivariate analysis with DS-GPA and found that the presence of neurological symptoms was independently associated with a shorter survival prognosis from diagnosis of brain metastases (hazard ratio 1.19).

For the study, the team analyzed a real-life cohort of 1531 patients with NSCLC brain metastases. Median age was 62 years; 57.4% were male, and 42.3% were female. Most of the patients (73.5%) had neurologic symptoms, including neurologic deficits (62.2%), symptoms of increased intracranial pressure (29.8%), and epileptic seizures (13.0%). 

Presence of increased intracranial pressure and seizures was to found have no impact on survival prognosis. However, median OS was significantly shorter for patients with neurologic defects compared with those without neurologic defects (7 months vs 11 months). Overall survival was also shorter for patients with memory disorders (6 months vs 8 months), ataxia (7 months vs 8 months), and vertigo (6 months vs 9 months).

Although brain metastases in patients with a synchronous diagnosis of NSCLC were more commonly oligo- to asymptomatic, median OS was shorter for those patients who present symptomatic brain metastases.

Reference

Steindl A, Yadavalli S, Gruber K, et al. Impact of neurological symptom burden on the survival prognosis in a real-life cohort of patients with non-small cell lung cancer brain metastases. Presented at: ESMO Congress 2019; September 27-October 1, 2019; Barcelona, Spain. Abstract 402PD.