Prognostic factors for brain metastasis in adolescent and young adult patients.

Abstract

e14011 Background: Adolescents and young adults (AYA), aged 15 to 39 at diagnosis, account for 2% of invasive cancers in US. Despite significant advances in cancer treatment, brain metastases (BM) remain an underexplored complication in this population, contributing to significant morbidity and mortality. This study aims to evaluate prognostic factors for BM in AYA patients (pts). Methods: Our study used the National Cancer Database (2010-2021) to analyze AYA patients diagnosed with the 20 most common cancer types. Patients with ≥6 months of follow-up and known survival status were included. Demographic and socioeconomic factors were analyzed by descriptive statistics. Cox analyses were used to identify potential prognostic factors. Kaplan–Meier analysis was conducted to evaluate median overall survival (mOS). Results: Of 382,241 AYA pts, 2,504 (0.65%) were diagnosed with BM with a median age of 34 years (IQR: 28–37). Most were male (51.7%) and White (75.9%). The most common causes of BM were lung (37.5%), testicular (15.5%), breast (14.9%), melanoma (13.8%), lymphoma (4.3%), sarcoma (3.3%) and colorectal (2.5%). Pts with BM were significantly more likely to have bone (40.1% vs 2.2%, P < 0.001) and lung metastases (44% vs 2.6%, P < 0.001), but were less likely to have liver metastases (26.2% vs 73.8%, P < 0.001) compared to those without BM. The mOS for pts with BM was 27.4 months (95% CI: 25.43–29.44), with 1-, 3-, 5- and 10-year overall survival (OS) rates of 75.6%, 43.5%, 34.8%, and 24.7%, respectively. When stratified by cancer group, testicular cancer (TC) had the best outcomes (mOS: NR, 5-y OS: 58.1%), while lung cancer (mOS: 22.7 months, 5-y OS: 25.8%) and melanoma (mOS: 22.6 months, 5-y OS: 35.1%) had the worst outcomes. In multivariate analysis, pts with TC had significantly better outcomes compared to other cancers (HR: 0.3, 95% CI: 0.14–0.72, p = 0.006). Treatment with stereotactic radiosurgery (SRS) significantly improved survival compared to whole-brain radiation therapy (HR: 0.8, 95% CI: 0.71–0.94, p = 0.004). Liver metastases (HR: 1.3, 95% CI: 1.18–1.50, p < 0.001) and lung metastases (HR: 1.2, 95% CI: 1.08–1.36, p = 0.001) were associated with worse survival. Conclusions: BMs in AYA pts are rare and outcomes appear more favorable than older populations. SRS use is associated with the best survival rates. Further research on tumor biology including genetic and epigenetic drivers, and strategies for early detection and prevention is necessary to improve outcomes in this unique population. Survival outcomes by cancer. All Testicular Breast Melanoma Lung Survival Rate%, (95% CI)1-Year3-Year 75.6(74-77.3)43.5(41.6-45.6) 81.7(77.9-85.7)60(55.1-65.2) 80.1(76.1-84.2)44.9(39.9-50.5) 68.6(63.9–73.7)40.4(35.4-46.1) 74.5(71.8-77.4)37.5(34.5-40.9) mOS (months)(95% CI) 27.4(25.4–29.4) NA(96.9-NA) 29.1(26.4-36.3) 22.6(18.1-29.4) 22.7(20.7-25.8)