Abstract
Purpose
The aim of this study was to analyse the correlation of extracranial metastasis sites (ECMs) to the incidence risk of brain metastasis (BMs) in stage IV non-small cell lung cancer (NSCLC).
Methods
18349 newly diagnosed patients were retrospectively analysed, and 4919 pairs of cases were matched by propensity score matching in a 1:1 ratio. Alternative factors were analysed by multivariable logistic regression analysis. And the interaction analysis and subgroup analysis were carried out.
Results
The incidences of Brain, Lung, Liver, Bone, Multiple and Other metastasis were 26.9%, 20.2%, 4.6%, 19.9%, 16.9% and 38.3%, respectively. Results suggested that Age, Race, Histological type, Grade, T stage, N stage and Organ metastasis site were risk factors (p < 0.05). The interaction analysis suggested interaction effects between the Primary site, T stage, N stage and Organ metastasis site. The subgroup analysis showed that the Organ metastasis site and the risk of BMs were statistically significant except that the Overlapping subgroup (p = 0.267) of the Primary site. And the incidence risk of BMs in Lung metastasis, Liver metastasis and Bone metastasis groups was lower than that in other metastasis group (OR 1, p < 0.05). There was no significant difference between the Multiple metastasis group and the other metastasis group (OR 1.091, p = 0.169).
Conclusion
Advanced age, non-Asian/Pacific Islander, non-squamous cell carcinoma, poorly differentiated grade, and higher T/N stage were risk factors for increased BMs in stage IV NSCLC, and the ECMs were associated with the risk of BMs.
Similar content being viewed by others
Data availability
The data that support the findings of this study are available from the first author HongXiang Gao upon reasonable request.
Abbreviations
- NSCLC:
-
Non-small cell lung cancer
- BMs:
-
Brain metastases
- ECMs:
-
Extracranial metastasis sites
- API:
-
Asian or Pacific Islander
- AI:
-
American Indian/Alaska Native
- SEER:
-
Surveillance, Epidemiology and End Results
- PSM:
-
Propensity score matching
References
Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P et al (2004) Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit cancer surveillance system. J Clin Oncol 22:2865–2872. https://doi.org/10.1200/jco.2004.12.149
Brown D, Smeets D, Székely B, Larsimont D, Szász AM et al (2017) Phylogenetic analysis of metastatic progression in breast cancer using somatic mutations and copy number aberrations. Nat Commun 8:14944. https://doi.org/10.1038/ncomms14944
Gundem G, Van Loo P, Kremeyer B, Alexandrov LB, Tubio JMC et al (2015) The evolutionary history of lethal metastatic prostate cancer. Nature 520:353–357. https://doi.org/10.1038/nature14347
Kuijpers C, Hendriks LEL, Derks JL, Dingemans AC, van Lindert ASR et al (2018) Association of molecular status and metastatic organs at diagnosis in patients with stage IV non-squamous non-small cell lung cancer. Lung Cancer (Amsterdam, Netherlands) 121:76–81. https://doi.org/10.1016/j.lungcan.2018.05.006
Morgensztern D, Ng SH, Gao F, Govindan R (2010) Trends in stage distribution for patients with non-small cell lung cancer: a national cancer database survey. J Thorac Oncol 5:29–33. https://doi.org/10.1097/JTO.0b013e3181c5920c
Mujoomdar A, Austin JH, Malhotra R, Powell CA, Pearson GD et al (2007) Clinical predictors of metastatic disease to the brain from non-small cell lung carcinoma: primary tumor size, cell type, and lymph node metastases. Radiology 242:882–888. https://doi.org/10.1148/radiol.2423051707
Nguyen DX, Bos PD, Massagué J (2009) Metastasis: from dissemination to organ-specific colonization. Nat Rev Cancer 9:274–284. https://doi.org/10.1038/nrc2622
Nguyen B, Fong C, Luthra A, Smith SA, DiNatale RG et al (2022) Genomic characterization of metastatic patterns from prospective clinical sequencing of 25,000 patients. Cell 185:563-575.e511. https://doi.org/10.1016/j.cell.2022.01.003
Riihimäki M, Hemminki A, Fallah M, Thomsen H, Sundquist K et al (2014) Metastatic sites and survival in lung cancer. Lung Cancer (Amsterdam, Netherlands) 86:78–84. https://doi.org/10.1016/j.lungcan.2014.07.020
Schouten LJ, Rutten J, Huveneers HA, Twijnstra A (2002) Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94:2698–2705. https://doi.org/10.1002/cncr.10541
Shan Q, Fan Y, Guo J, Han X, Wang H et al (2019) Relationship between tumor size and metastatic site in patients with stage IV non-small cell lung cancer: a large SEER-based study. PeerJ 7:e7822. https://doi.org/10.7717/peerj.7822
Tamura T, Kurishima K, Nakazawa K, Kagohashi K, Ishikawa H et al (2015) Specific organ metastases and survival in metastatic non-small-cell lung cancer. Mol Clin Oncol. https://doi.org/10.3892/mco.2014.410
Ullah I, Karthik GM, Alkodsi A, Kjällquist U, Stålhammar G et al (2018) Evolutionary history of metastatic breast cancer reveals minimal seeding from axillary lymph nodes. J Clin Investig 128:1355–1370. https://doi.org/10.1172/jci96149
Wang H, Wang Z, Zhang G, Zhang M, Zhang X et al (2020) Driver genes as predictive indicators of brain metastasis in patients with advanced NSCLC: EGFR, ALK, and RET gene mutations. Cancer Med 9:487–495. https://doi.org/10.1002/cam4.2706
Waqar SN, Samson PP, Robinson CG, Bradley J, Devarakonda S et al (2018a) Non-small-cell lung cancer with brain metastasis at presentation. Clin Lung Cancer 19:e373-379. https://doi.org/10.1016/j.cllc.2018.01.007
Waqar SN, Waqar SH, Trinkaus K, Gadea CA, Robinson CG et al (2018b) Brain metastases at presentation in patients with non-small cell lung cancer. Am J Clin Oncol 41:36–40. https://doi.org/10.1097/coc.0000000000000230
Wood SL, Pernemalm M, Crosbie PA, Whetton AD (2014) The role of the tumor-microenvironment in lung cancer-metastasis and its relationship to potential therapeutic targets. Cancer Treat Rev 40:558–566. https://doi.org/10.1016/j.ctrv.2013.10.001
Zhang W, Bado IL, Hu J, Wan YW, Wu L et al (2021) The bone microenvironment invigorates metastatic seeds for further dissemination. Cell 184:2471-2486.e2420. https://doi.org/10.1016/j.cell.2021.03.011
Zhu H, Zhou L, Guo Y, Yang G, Dong Q et al (2021) Factors for incidence risk and prognosis in non-small-cell lung cancer patients with synchronous brain metastasis: a population-based study. Future Oncol (London, England) 17:2461–2473. https://doi.org/10.2217/fon-2021-0103
Zuo C, Liu G, Bai Y, Tian J, Chen H (2021) The construction and validation of the model for predicting the incidence and prognosis of brain metastasis in lung cancer patients. Transl Cancer Res 10:22–37. https://doi.org/10.2103/tcr-20-2745
Funding
This research did not receive any specific grant from the public, commercial, or not-for-profit funding agencies.
Author information
Authors and Affiliations
Contributions
XiaoZhi Zhang: Corresponding author, contributed to the conception of the study; HongXiang Gao: First author, performed the data analyses and wrote the manuscript; Sheng Qiang Dang, Li Dai, Jun Wei Zhang: contributed significantly to analysis and manuscript preparation.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zhang, X., Gao, H., Dang, S. et al. Extracranial metastasis sites correlate to the incidence risk of brain metastasis in stage IV non-small cell lung cancer: a population-based study. J Cancer Res Clin Oncol 149, 6293–6301 (2023). https://doi.org/10.1007/s00432-022-04548-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-022-04548-3