Background: Real-world data provide insights into populations underrepresented in clinical trials such as non-small-cell cancer (NSCLC) patients with brain metastases (BMs). Despite global survival improvement due to novel drug employment, their impact in resource-limited settings like Serbia remains underexplored. This study analyzes the overall survival (OS) of NSCLC patients with BMs treated in routine clinical practice, considering patient-, disease- and treatment-related factors amid restricted access to novel drugs. Methods: We retrospectively analyzed 267 NSCLC patients diagnosed with BMs from 2018 to 2022 at a single Serbian clinical center. Inclusion required histologically confirmed NSCLC, radiologically verified BMs and complete clinical data. OS was defined as the time from BM verification to death or last follow-up. Kaplan–Meier curves and Cox regression were used for survival analysis. Results: Median OS (mOS) was 5.0 months. Univariate analysis linked age < 65 years, female gender, single BM, asymptomatic BMs, ECOG PS 0–1, BM verification at diagnosis and combined systemic and local therapy to better OS. Combined therapy offered the best survival rates (mOS: 9.0 months), while best supportive care and local-only therapy both resulted in a poor mOS of 2.0 months. Immunotherapy and targeted therapy were associated with the highest mOS, outperforming chemotherapy alone (13.0 vs. 7.0 months,p< 0.001). Multivariate analysis confirmed younger age, single BM, early BM verification and combined therapy as independent predictors of improved survival. Conclusions: limited access to novel therapies remains associated with poor patient survival, highlighting the need for better global availability.
背景：真实世界数据为临床试验中代表性不足的群体提供了重要见解，例如伴有脑转移的非小细胞肺癌患者。尽管新型药物的应用在全球范围内改善了患者生存，但其在塞尔维亚等资源有限地区的实际影响尚未得到充分研究。本研究旨在分析常规临床实践中接受治疗的脑转移非小细胞肺癌患者的总生存期，重点关注在新型药物可及性受限背景下患者、疾病及治疗相关因素的影响。 方法：我们回顾性分析了2018年至2022年间在塞尔维亚某临床中心确诊的267例脑转移非小细胞肺癌患者。纳入标准包括组织学确诊的非小细胞肺癌、影像学证实的脑转移以及完整的临床数据。总生存期定义为从脑转移确诊至死亡或末次随访的时间。采用Kaplan-Meier曲线和Cox回归进行生存分析。 结果：患者中位总生存期为5.0个月。单因素分析显示，年龄＜65岁、女性、单发脑转移、无症状脑转移、ECOG PS评分0-1分、确诊时即发现脑转移以及接受全身联合局部治疗与更好的总生存期相关。联合治疗组生存率最佳（中位总生存期：9.0个月），而最佳支持治疗组和单纯局部治疗组的中位总生存期均仅为2.0个月。免疫治疗和靶向治疗组患者的中位总生存期最高，显著优于单纯化疗组（13.0个月 vs. 7.0个月，p＜0.001）。多因素分析证实，年龄较轻、单发脑转移、早期发现脑转移以及接受联合治疗是改善生存的独立预测因素。 结论：新型疗法可及性有限仍与患者不良预后相关，这凸显了提高全球药物可及性的迫切需求。
肿瘤(癌症)患者之家