P196. The Prevalence and Predictors of Brain Metastases in Patients with T1N0 Non-Small-Cell Lung Cancer; A Contemporary Analysis of Current NCCN Guidelines
Massachusetts General Hospital
Winchester, MA
United States - Contact Me
Dr. Chi-Fu Jeffrey Yang is a thoracic surgeon at Massachusetts General Hospital, Associate Professor of Surgery at Harvard Medical School, and Founding Director of the Center for Artificial Intelligence and Innovation Research (CAIIRE). He has received numerous awards for excellence in clinical care and teaching, including the 2021 Harvard Medical School Charles McCabe Faculty Prize for Excellence in Teaching.
Dr. Yang leads multiple studies, including as co-principal investigator and project leader of a $3.5M NIH R01-funded trial on postoperative complications and recovery in cardiothoracic patients, and a $1.5M AHRQ R18-funded study on lung cancer screening on Black women at risk of developing lung cancer. He is the PI of a $450,000 NIH R21 study evaluating lung screening modeling. He is also the co-PI of the Boston Lung Cancer Study, a cancer epidemiological study of over 11,000 patients. He serves as Vice Chair of the Alliance Thoracic Surgery Group and has authored over 180 publications and senior-authored research studies in journals such as JAMA, BMJ, Journal of Clinical Oncology, JAMA Oncology, Journal of Thoracic Oncology, Annals of Surgery, and Chest.
Dr. Yang is a national leader in lung cancer screening advocacy. He founded the American Lung Cancer Screening Initiative, a 501(c)(3) nonprofit that has worked across all 50 states to promote screening and has taught over 70,000 community members about the importance of the early detection of lung cancer. Since 2020, he has worked on Senate Resolutions 780, 462, 863, 512 and 912 to raise awareness of lung cancer and screening, all passed unanimously by all 100 U.S. Senators. In recognition of his lung cancer screening efforts, he has received the 2021 HMS Dean's Community Service Faculty Award, the 2024 HMS Equity, Social Justice, and Advocacy Award, the 2024 Upstage Lung Cancer Fan Award, the 2024 Boston Bruins Community All-Star Award, and the 2025 Inaugural Kraft Center Community Health Champion Award.
Description
Currently, U.S. national guidelines do not recommend routine screening for brain metastases with brain MRI for patients with T1N0 non-small-cell lung cancer (NSCLC). The objective of this study is to evaluate the prevalence and predictors of brain metastases in patients with T1 N0 NSCLC.
Methods
The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify adults with primary NSCLC between 2010-2019. Patients with concomitant cancer diagnoses and with missing variables were excluded from analysis. Patients were considered to have undergone pre-treatment brain MRI if the imaging occurred within two months of diagnosis. Outcomes of interest included the presence of, and factors correlated with having brain metastases. Multivariable logistic regression was utilized to adjust outcomes for age, sex, race, comorbid conditions, T-status and tumor histopathology, reported as adjusted odds ratios (aOR) with 95% confidence intervals.
Results
Of 37,737 adults with T1N0 disease included for analysis, 18,629 (49.4%) underwent a brain MRI at time of diagnosis and 1,690 (4.5%) were noted to have a brain metastasis. Those with brain metastases were younger (72.8 vs 74.0 years, p<0.001), more frequently male (46.6 vs 43.9%, p=0.03), more likely to identify as Black (8.2 vs 6.8%, p=0.01), and more likely to have any smoking history (88.8 vs 85.8%, p<0.001). Compared to those without brain metastases, this cohort was more frequently Stage T1c (53.8 vs 45.1%, p<0.001) and diagnosed with Adenocarcinoma (54.8 vs 44.1%, p<0.001) and Large Cell Carcinoma (2.2 vs 1.02%, p<0.001) rather than Squamous Cell Carcinoma (17.4 vs 22.6%, p<0.001). On multivariable-adjusted analysis, factors associated with increased likelihood of having brain metastases included younger age (aOR: 0.98 per year, 95% CI: 0.98-0.99, Figure), Black race (aOR: 1.15, 95% CI: 1.01-1.31, ref: White), smoking status (aOR: 1.33, 95% CI: 1.14-1.54). Stage T1c (aOR: 1.35, 95% CI: 1.11-1.65, ref: T1a, Figure), Adenocarcinoma (aOR: 1.76, 95% CI: 1.55-1.99) and Large Cell Carcinoma (aOR: 3.39, 95% CI: 1.83-3.61, ref: Squamous Cell Carcinoma).
Conclusions
In this national analysis of T1N0 NSCLC, the prevalence of brain metastases was 4.5%. In the setting of T1N0Mx NSCLC, evaluation with brain imaging may be considered in patients with high risk features, such as those with T1c Adenocarcinoma.
Authors
Catherine Williamson (1), Alexandra Potter (1), Soneesh Kothagundla (1), Camille Mathey-Andrews (1), Jane Yanagawa (2), Mongwei Lin (3), Michael Lanuti (4), Chi-Fu Yang (1)
Institutions
(1) Massachusetts General Hospital, Boston, MA, (2) David Geffen School of Medicine at UCLA, Los Angeles, CA, (3) National Taiwan University, Taipei, NA, (4) Harvard University, Boston, MA