Background: Brain metastases are a common and devastating complication of non-small cell lung cancer (NSCLC), severely affecting prognosis and quality of life. Despite increasing interest in the role of platelets in tumor progression and dissemination, the potential impact of antiplatelet therapy on brain metastasis in NSCLC remains underexplored. Methods: In this retrospective observational study, we analyzed data from 650 patients diagnosed with NSCLC over a four-year period to evaluate whether prior or subsequent exposure to antiplatelet agents correlates with a reduced incidence of brain metastases. Results: Patients exposed to antiplatelet therapy, predominantly aspirin, presented with more comorbidities and were generally older. Despite these differences, they showed a significantly lower risk of developing brain metastases during the disease course (6.9% vs. 20.0%,p< 0.001), particularly among those with advanced-stage disease at diagnosis. A longer time to metastasis development was also observed in antiplatelet users (77.5 vs. 62.6 months,p< 0.001), along with improved progression-free survival. Additionally, patients on antiplatelets before diagnosis had a lower probability of presenting brain metastases at the time of diagnosis (3.9% vs. 12.1%,p= 0.014), and no cases of brain metastases occurred in patients who started antiplatelet therapy shortly after diagnosis. These findings highlight the potential of antiplatelet agents to interfere with key mechanisms of metastatic spread, including immune evasion and premetastatic niche formation. Conclusions: Importantly, this study provides one of the first real-world analyses suggesting a consistent and stage-dependent association between antiplatelet use and reduced brain metastatic burden in NSCLC. By bridging the gap between preclinical insights and clinical outcomes, our work offers a novel and clinically relevant perspective that supports further research into the integration of antiplatelet therapy in NSCLC management.
背景：脑转移是非小细胞肺癌（NSCLC）常见且严重的并发症，严重影响患者预后及生活质量。尽管血小板在肿瘤进展与播散中的作用日益受到关注，但抗血小板治疗对NSCLC脑转移的潜在影响仍未得到充分探索。方法：本回顾性观察研究分析了四年间650例NSCLC确诊患者的数据，旨在评估既往或后续使用抗血小板药物是否与脑转移发生率降低相关。结果：接受抗血小板治疗（主要为阿司匹林）的患者合并症更多、年龄普遍更大。尽管存在这些差异，该组患者在病程中发生脑转移的风险显著降低（6.9% vs. 20.0%，p<0.001），在确诊时已属晚期的患者中尤为明显。抗血小板药物使用者出现转移的时间显著延后（77.5个月 vs. 62.6个月，p<0.001），无进展生存期亦有所改善。此外，确诊前使用抗血小板药物的患者在确诊时出现脑转移的概率更低（3.9% vs. 12.1%，p=0.014），而确诊后短期内开始抗血小板治疗的患者未出现脑转移病例。这些发现提示抗血小板药物可能通过干预免疫逃逸与转移前微环境形成等关键机制影响转移进程。结论：本研究首次通过真实世界数据分析表明，抗血小板药物使用与NSCLC脑转移负荷降低存在持续且分期依赖的关联。通过弥合临床前研究与临床结局之间的认知鸿沟，本研究为抗血小板治疗融入NSCLC综合管理提供了新颖且具临床意义的视角，值得开展进一步探索。
肿瘤(癌症)患者之家