Background/Objectives: Immune checkpoint inhibitors (ICIs) have improved outcomes in advanced lung cancer, but their real-world impact on patients with brain metastases remains insufficiently characterized. This study aimed to compare treatment outcomes before and after the introduction of ICIs and to identify prognostic factors in patients with lung cancer brain metastases. Methods: We retrospectively analyzed 186 patients treated for brain metastases from lung cancer at our institution between 2014 and 2023. Patients were classified into a Pre-ICI group (N = 93, 2014–2018) and a Post-ICI group (N = 93, 2019–2023). Overall survival (OS) was analyzed by Kaplan–Meier method and Cox regression. Baseline factors included age, sex, histology, Charlson–Deyo score, extracranial metastases, radiotherapy, systemic therapy, and neutrophil-to-lymphocyte ratio (NLR, cutoff = 4). Results: Median OS improved significantly in the Post-ICI group compared with the Pre-ICI group (10.9 vs. 4.7 months,p< 0.01). When stratified by systemic therapy, median OS was 4.7 months with conventional chemotherapy, 14.7 months with molecular targeted therapy overall, further prolonged to 25.5 months in the Post-ICI era, and 23.4 months for all patients receiving ICIs. The most notable benefits were observed in patients with squamous cell carcinoma and small cell carcinoma. Patients with NLR ≥ 4 showed shorter OS, but NLR did not remain significant in multivariate analysis. In EGFR-mutant adenocarcinoma, the survival benefit from ICIs was limited. Conclusions: ICIs significantly improved survival in patients with lung cancer brain metastases, particularly those with squamous cell carcinoma or small cell carcinoma. NLR may provide supportive prognostic information, while molecular targeted therapy and ICIs represent major drivers of improved survival in this population.
背景/目的：免疫检查点抑制剂（ICIs）改善了晚期肺癌患者的预后，但其对脑转移患者的真实世界影响仍缺乏充分描述。本研究旨在比较ICIs引入前后的治疗结局，并识别肺癌脑转移患者的预后因素。方法：我们回顾性分析了2014年至2023年间在本机构接受治疗的186例肺癌脑转移患者。患者被分为ICI前组（N = 93，2014–2018年）和ICI后组（N = 93，2019–2023年）。采用Kaplan–Meier法和Cox回归分析总生存期（OS）。基线因素包括年龄、性别、组织学类型、Charlson–Deyo评分、颅外转移、放疗、全身治疗以及中性粒细胞与淋巴细胞比值（NLR，截断值=4）。结果：与ICI前组相比，ICI后组的中位OS显著改善（10.9个月 vs. 4.7个月，p < 0.01）。按全身治疗分层分析，传统化疗的中位OS为4.7个月，分子靶向治疗总体为14.7个月，在ICI后时代进一步延长至25.5个月，而所有接受ICIs治疗的患者为23.4个月。最显著的生存获益见于鳞状细胞癌和小细胞癌患者。NLR ≥ 4的患者OS较短，但在多变量分析中NLR未保持显著意义。在EGFR突变腺癌患者中，ICIs带来的生存获益有限。结论：ICIs显著改善了肺癌脑转移患者的生存期，尤其是鳞状细胞癌或小细胞癌患者。NLR可能提供辅助预后信息，而分子靶向治疗和ICIs是该人群生存改善的主要驱动因素。
肿瘤(癌症)患者之家