Table 6.
Survival estimates and univariable regression models for all-cause mortality of patients with brain metastases by primary tumor type
| BM at time of primary cancer diagnosis | NSCLCa (N = 2007) | SCLC (N = 444) | Breast (N = 71) | Melanoma (N = 109) | Kidney (N = 71) | Colorectal (N = 29) | Esophagus (N = 26) | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Median survival (mo.) |
HR (95% CI) | P value | Median survival (mo.) |
HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | |
| Initial BM management strategy, N (%) b | |||||||||||||||||||||
| Any non-stereotactic brain-directed radiation | 2.5 | Ref | -- | 3.0 | Ref | -- | 2.3 | Ref | -- | 2.0 | Ref | -- | 2.3 | Ref | -- | 2.8 | Ref | -- | 2.7 | Ref | -- |
| Any stereotactic brain-directed radiation | 7.6 | 0.50 (0.43–0.57) | <0.001 | 8.8 | 0.44 (0.25–0.75) | 0.003 | 10.1 | 0.70 (0.34–1.46) | 0.34 | 5.3 | 0.51 (0.27–0.94) | 0.03 | 2.4 | 0.59 (0.30–1.19) | 0.14 | 11.3 | 0.58 (0.21–1.64) | 0.31 | 12.6 | 0.15 (0.02–1.35) | 0.09 |
| Any neurosurgical resection | 6.7 | 0.58 (0.50–0.67) | <0.001 | 4.6 | 0.75 (0.51–1.09) | 0.13 | 4.4 | 0.72 (0.30–1.75) | 0.47 | 8.7 | 0.41 (0.24–0.70) | 0.001 | 2.4 | 0.79 (0.35–1.78) | 0.57 | 8.4 | 0.44 (0.10–1.95) | 0.28 | 8.3 | 0.37 (0.14–0.99) | 0.05 |
| Systemic therapy without local brain-directed therapyc | 4.3 | 0.74 (0.61–0.91) | 0.003 | 5.7 | 0.83 (0.63–1.10) | 0.19 | 18.5 | 0.49 (0.19–1.28) |
0.15 | 4.4 | 0.81 (0.28–2.30) | 0.69 | N/A | N/A | N/A | N/A | N/A | N/A | 2.3 | 2.25 (0.59–8.57) | 0.23 |
| Other/noned | 1.1 | 1.64 (1.46–1.83) | <0.001 | 1.2 | 2.05 (1.61–2.60) | <0.001 | 0.5 | 3.49 (1.82–6.67) | <0.001 | 1.1 | 1.71 (0.97–3.01) | 0.06 | 0.9 | 1.62 (0.87–3.02) | 0.13 | 2.0 | 0.99 (0.35–2.75) | 0.98 | 3.8 | 1.16 (0.25–5.46) | 0.85 |
| BM after primary cancer diagnosis | NSCLC a (N = 2994) | SCLC (N = 839) | Breast (n = 1294) | Melanoma (N = 811) | Kidney (N = 351) | Colorectal (N = 560) | Esophagus (N = 157) | ||||||||||||||
| Median survival (mo.) | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | Median survival | HR (95% CI) | P value | |
| Initial BM management strategy, N (%) b | |||||||||||||||||||||
| Any non-stereotactic brain-directed radiation | 2.8 | Ref | -- | 4.0 | Ref | -- | 3.7 | Ref | -- | 2.3 | Ref | -- | 2.8 | Ref | -- | 2.1 | Ref | -- | 1.9 | Ref | -- |
| Any stereotactic brain-directed radiation | 7.9 | 0.56 (0.49–0.63) | <0.001 | 5.5 | 0.66 (0.48–0.92) | 0.01 | 8.6 | 0.60 (0.48–0.74) | <0.001 | 7.6 | 0.42 (0.33–0.53) | <0.001 | 7.3 | 0.58 (0.40–0.83) | 0.003 | 5.0 | 0.62 (0.47–0.82) | <0.001 | 3.3 | 0.74 (0.45–1.23) | 0.24 |
| Any neurosurgical resection | 8.3 | 0.50 (0.43–0.58) | <0.001 | 4.8 | 0.77 (0.37–1.63) | 0.49 | 7.7 | 0.66 (0.52–0.83) | <0.001 | 4.9 | 0.51 (0.40–0.66) | <0.001 | 18.6 | 0.35 (0.23–0.55) | <0.001 | 5.9 | 0.56 (0.42–0.75) | <0.001 | 7.0 | 0.40 (0.24–0.67) | <0.001 |
| Systemic therapy without local brain-directed therapyc | 5.4 | 0.68 (0.60–0.78) | <0.001 | 3.7 | 1.10 (0.90–1.35) | 0.33 | 6.2 | 0.65 (0.55–0.77) | <0.001 | 2.8 | 0.72 (0.53–0.98) | 0.03 | 2.9 | 0.84 (0.57–1.24) | 0.39 | 4.7 | 0.54 (0.37–0.77) | <0.001 | 1.3 | 0.77 (0.46–1.27) | 0.30 |
| Other/noned | 1.6 | 1.15 (1.05–1.26) | 0.003 | 2.1 | 1.13 (0.96–1.34) | 0.15 | 2.8 | 0.87 (0.75–1.01) | 0.06 | 1.4 | 0.97 (0.81–1.16) | 0.72 | 2.1 | 1.04 (0.79–1.36) | 0.79 | 1.7 | 0.87 (0.71–1.08) | 0.21 | 1.0 | 1.13 (0.72–1.78) | 0.59 |
Abbreviations: BM, brain metastasis; CI, confidence interval; HR, hazard ratio; N/A, not applicable because no patients in this treatment group; NSCLC, non-small-cell lung cancer; SCLC, small cell lung cancer.
aIncludes lung primaries that are not specifically listed as adenocarcinoma, squamous cell, adenosquamous, large cell, or bronchoalveolar (a histology still designated by SEER).
bPatients were considered recipients of a treatment if at least one of the relevant administrative codes (Table A1) was present within 1 month prior—2 months after BM diagnosis for brain-directed radiation or 1 month prior—1 month after BM diagnosis for neurosurgical resection.
cMay underestimate percent of patients receiving systemic therapy given that data on receipt of oral systemic agents were only available for patients with Part D coverage.
dMay include patients who received systemic therapy but for whom this information was not captured by claims due to lack of Part D coverage.