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Publications

Journal Article Ahead of print

PubMed: 41872110 DOI: 10.1002/ijc.70456

Prediction of the individual risk for the development of brain metastases in patients with non-oncogene-addicted non-small cell lung cancer: Real-world data from the German prospective CRISP registry (AIO-TRK-0315).

Int J Cancer

Authors: Fabian Acker, Katharina Wenger, Martin Reck, Cornelius F Waller, Petra Hoffknecht, Andre Bethge, Arnd Nusch, Marcel Reiser, Christiane Bernhardt, Michael Bendel, Carolin Lennartz, Annette Fleitz, Martina Jänicke, Paula Ludwig, Annika Groth, Frank Griesinger, Michael Thomas, Wilfried E E Eberhardt, Martin Sebastian

Affiliations

  • Goethe University Frankfurt, University Hospital, Department of Medicine 2, Hematology and Oncology, Frankfurt, Germany.
  • Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Frankfurt, Germany.
  • LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
  • Department of Haematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Department of Hematology/Oncology, Niels-Stensen-Kliniken Franziskus Hospital Harderberg, Georgsmarienhütte, Germany.
  • Department of Pulmonology and Respiratory Medicine, Clinic Bremen-Ost, Bremen, Germany.
  • MVZ für Hämatologie und Onkologie, Ratingen, Germany.
  • Praxis Internistischer Onkologie und Hämatologie, Köln, Germany.
  • Gemeinschaftspraxis für Hämatologie & Onkologie, Dortmund, Germany.
  • MVZ West GmbH, Würselen, Germany.
  • Statistics, iOMEDICO, Freiburg, Germany.
  • Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany.
  • AIO-Studien-gGmbH, Berlin, Germany.
  • Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany.
  • Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, DKFZ and Heidelberg University Hospital, Heidelberg, Germany.
  • Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
  • Department of Medical Oncology, West German Cancer Cent, University Hospital Essen, Essen, Germany.
  • Frankfurt Cancer Institute, Goethe University, Frankfurt, Germany.

Abstract

Brain metastases (BM) from non-small cell lung cancer (NSCLC) are a relevant cause of morbidity and mortality. This study aims to identify a population at high risk for BM in order to inform personalized follow-up strategies in the future. We have therefore developed and validated a point-based risk classifier for the risk of BM1 in patients with metastatic non-oncogene-addicted NSCLC without BM at disease onset. A total of 3139 patients were included from the German CRISP lung cancer registry and randomly assigned to a derivation and validation set (2:1). In the derivation set, a Fine and Gray model was developed considering BM and death competing risks. A point-based risk classifier was derived and evaluated in the validation set. Of the baseline variables included in the risk model, ≥4 versus 0 extrathoracic metastatic sites (hazard ratio [HR], 2.69; 95% CI, 1.45-5.00), N3 vs. N0 disease (2.29; 1.41-3.72), and age < 65 vs. ≥75 years (2.03; 1.39-2.98) were the strongest predictors of BM development. Using the risk classifier, high-risk patients in the derivation set had a cumulative incidence of BM of 23.7% (95% CI, 16.7-30.1) at 18 months compared to 10.3% (8.9-11.7) in low-risk patients (HR, 2.44; 95% CI, 1.87-3.19). In the validation set, the cumulative incidence of BM at 18 months was 14.7% (11.5-17.8) and 8.9% (6.2-11.6) in the high-risk and low-risk groups, respectively (HR, 1.54; 95% CI, 1.08-2.20). In conclusion, our point-based risk classifier is able to identify NSCLC patients at high risk for BM development that may benefit from intensified brain surveillance.

MeSH

Registries, Oncogenes, Cells, Lung, Incidence, Brain, Neoplasms, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms, Neoplasm Metastasis, Small Cell Lung Carcinoma, Risk Factors