Risk of development of brain metastases according to the IASLC/ATS/ERS lung adenocarcinoma classification in locally advanced and metastatic disease. (May 2021)

• Record Type: Journal Article
• Authors: Arrieta, Oscar; Salas, Alejandro Avilés; Cardona, Andrés F.; Díaz-García, Diego; Lara-Mejía, Luis; Escamilla, Ixel; García, Ariana Pereira; Pérez, Enrique Caballé; Raez, Luis E.; Rolfo, Christian; Rosell, Rafael
• Is Part Of: Lung cancer. Volume 155(2021)
• Page Start: 183
• Page End: 190
• Publication Date: 2021-05
• Subjects: BM Brainmetastases -- IASLC InternationalAssociation for the Study of Lung Cancer -- ATS American Thoracic Society -- ERS European Respiratory Society -- LADC Lung adenocarcinoma -- GPA GradedPrognostic Assessment -- DS-GPA DiseaseSpecific Graded Prognostic Assessment -- ECM Extracranialmetastases -- EGFR Epidermalgrowth factor receptor -- ALK Anaplasticlymphoma kinase -- WSE Woodsmoke exposure; Central nervous system metastases -- Histologic grade -- Adenocarcinoma subtype -- Differentiation grade -- Lung cancer; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2021.01.023
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: In the present study IASLC/ATS/ERS classification was useful to identify a high risk population of developing brain metastases in advanced lung adenocarcinoma. The solid predominant histologic subtype consistently had a significantly higher probability of developing brain metastases even after adjusting by the histological grade and cofounding variables. According to the histologic grade, moderately differentiated tumors had the highest risk of brain affection irrespective of the lung predominant adenocarcinoma subtype. IASLC/ATS/ERS classification might suggest more aggressive clinical approaches and closer monitoring in patients with increased hazards for brain metastases development, integrating this classification for risk stratification. Abstract: Introduction: Brain metastases (BM) are frequent among lung cancer patients, affecting prognosis and quality of life. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) lung adenocarcinoma (LADC) classification (IASLC/ATS/ERS) has prognostic impact in early-stage disease; however, its role in the advanced setting is not precise. This study aims to determine the correlation between the predominant histological subtype and the risk of developing brain metastases (BM) in locally advanced and metastatic (stages IIIB-IV) LADC. Methods: A total of 710 patients with LADC were treated at our institution from January 2010 to December 2017. After excluding patients with brain metastases at diagnoses (n = 151), they were categorized according to the IASLC/ATS/ERS LADC classification to estimate the risk of developing brain metastases. A competing risk analysis was employed, considering death a competing risk event. Results: From 559 patients, the mean age was 59 ± 13.2 years, women (52.4 %), and clinical-stage IV (79.2 %). LADC subtypes distribution was lepidic (11.6 %), acinar (37.9 %), papillary (10.2 %), micropapillary (6.8 %), and solid (33.5 %). A total of 27.0 % of patients developed BM, 32.9 % died without brain affection, and 40.0 % did not progress. The predominantly solid subtype showed the greatest probability of all subtypes for developing BM [HR 4.0; 95 % CI (1.80−8.91), p = 0.0006], followed by micropapillary [HR1.11; 95 % CI (0.36−3.39), p = 0.85). The solid subtype, moderately differentiated tumors, age, and ECOG PS (>2) were associated with increased hazards in the multivariate analysis. CONCLUSION: According to the IASLC/ATS/ERS classification, the predominantly solid pattern was significantly associated with an increased risk of developing BM in patients with locally advanced and metastatic LADC. Its prognostic value might help explore novel clinical approaches, modify monitoring for earlier detection, prevent complications, and reduce morbidity.