Background/Objectives: Brain metastases (BM) are common in small cell lung cancer (SCLC) and portend poor outcomes. Contemporary determinants of survival in the modern treatment era remain incompletely defined. We evaluated factors associated with overall survival (OS) among patients with SCLC and BM using a recent, nationally representative dataset.Methods: We identified adults diagnosed with SCLC and brain metastases between 2018 and 2020 in the National Cancer Database (NCDB). Demographic, clinical, treatment, and survival data were extracted for analysis. Unadjusted OS was estimated using Kaplan–Meier methods. Multivariable Cox proportional hazards models identified factors associated with mortality, with proportional hazards (PH) assessed using scaled Schoenfeld residuals. Complementary Accelerated Failure Time (AFT) modeling was performed to confirm robustness.Results: Of 62,671 SCLC cases, 11,074 (17.7%) had BM, including 32.6% with brain-only disease. Median overall survival (mOS) was 6.6 months (95% CI, 6.47–6.87); patients with brain-only disease had an mOS of 8.8 months (8.38–9.26), compared with 5.95 months (5.75–6.18) for those with concurrent extracranial metastases. In multivariable analysis, age ≥ 65 years (HR 1.13,p< 0.001) was associated with higher mortality, whereas female sex (HR 0.87,p< 0.001), Black (HR 0.88,p= 0.001), Asian (HR 0.80,p= 0.022), and Hispanic (HR 0.87,p= 0.008) patients had lower hazards. Worse outcomes were associated with public or no insurance, lower income, non-academic facilities, and extracranial metastases; educational attainment was not significant. Proportional hazards assumptions were largely met with minor deviations, and AFT modeling confirmed consistent results. Treatment modality remained independently associated with survival in both models.Conclusions: In this contemporary national cohort, survival among patients with SCLC and brain metastases was influenced by multiple clinical, sociodemographic, and treatment factors, including age, sex, insurance status, facility type, and extent of metastatic disease. Treatment modality remained an independent predictor of survival. These results provide updated real-world benchmarks and highlight the need for prospective studies to define optimal management strategies in this high-risk population.
**背景/目的：** 脑转移是小细胞肺癌的常见并发症，且预后不良。在现代治疗时代，影响生存的当代决定因素仍未完全明确。本研究利用近期具有全国代表性的数据集，评估了伴有脑转移的小细胞肺癌患者总生存期的相关因素。 **方法：** 我们从美国国家癌症数据库中识别出2018年至2020年间诊断为小细胞肺癌伴脑转移的成年患者。提取人口统计学、临床、治疗和生存数据进行分析。采用Kaplan-Meier法估计未调整的总生存期。通过多变量Cox比例风险模型识别与死亡率相关的因素，并使用标度化Schoenfeld残差评估比例风险假设。同时进行补充性的加速失效时间建模以确认结果的稳健性。 **结果：** 在62,671例小细胞肺癌病例中，11,074例（17.7%）伴有脑转移，其中32.6%为仅脑转移。中位总生存期为6.6个月（95% CI，6.47–6.87）；仅脑转移患者的中位总生存期为8.8个月（8.38–9.26），而同时存在颅外转移的患者为5.95个月（5.75–6.18）。多变量分析显示，年龄≥65岁与更高的死亡率相关（HR 1.13，p<0.001），而女性（HR 0.87，p<0.001）、黑人（HR 0.88，p=0.001）、亚裔（HR 0.80，p=0.022）和西班牙裔（HR 0.87，p=0.008）患者的死亡风险较低。预后较差与公共保险或无保险、较低收入、非学术型医疗机构以及存在颅外转移相关；教育程度无显著影响。比例风险假设基本满足，仅有轻微偏离，加速失效时间建模结果一致。在两种模型中，治疗方式均与生存期独立相关。 **结论：** 在这一当代全国性队列中，伴有脑转移的小细胞肺癌患者的生存期受到多种临床、社会人口学及治疗因素的影响，包括年龄、性别、保险状况、医疗机构类型和转移范围。治疗方式仍是生存期的独立预测因素。这些结果为现实世界提供了更新的基准数据，并强调需要开展前瞻性研究来确定这一高危人群的最佳管理策略。
肿瘤(癌症)患者之家