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Objective <p>This study retrospectively analyzed prognostic factors and quality of life in patients with Non-Small Cell Lung Cancer–Leptomeningeal Metastasis (NSCLC-LM), stratified by the presence or absence of concomitant Parenchymal Metastasis (PM), to inform clinical stratification and individualized therapy.</p> Methods <p>We retrospectively reviewed 43 NSCLC-LM patients diagnosed at the Affiliated People’s Hospital of Jiangsu University from September 2016 to April 2025, and classified them into LM-PM and LM-noPM groups according to brain parenchymal metastasis status. The primary endpoint was median overall survival (mOS). Prognostic factors were assessed, and quality of life was evaluated before and after treatment. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors. Quality of life scores were compared using paired sample t-tests. Scale reliability was assessed via Pearson correlation coefficients and Cronbach’s alpha. Statistical significance was defined as a two-sided <i>P</i>-value &lt; 0.05.</p> Results <p>The mOS was 5.0 months in both groups. Notably, the LM-noPM group demonstrated higher 1-year and 2-year survival rates, indicating a possible long-term survival advantage, although this trend did not reach statistical significance. Multivariate analysis identified non-receipt of anti-angiogenic therapy, adrenal metastasis, and elevated Platelet–Lymphocyte Ratio (PLR) as independent risk factors for poor prognosis. Among patients with good performance status, meningeal irritation signs also constituted an independent risk factor. Quality of life assessment revealed that comprehensive treatment significantly improved global health status and functional domains while reducing symptom burden.</p> Conclusion <p>Although NSCLC-LM patients without PM showed a non-significant trend toward improved long-term survival (reflected by numerically higher 1- and 2-year survival rates), the key independent risk factors associated with poor prognosis were the absence of anti-angiogenic therapy after LM diagnosis, the presence of adrenal metastasis, and an elevated PLR. These findings remained consistent among patients with good performance status, among whom meningeal irritation signs also independently predicted worse outcomes. Moreover, comprehensive treatment significantly alleviated symptom burden and enhanced quality of life across multiple domains, supporting longer survival with improved quality.</p>

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Prognostic factors and quality of life in non-small cell lung cancer with leptomeningeal metastasis: a dichotomous pattern based on parenchymal involvement

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月10日

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  • Yiyao Zhu,
  • Zhiyuan Qiu,
  • Lihua Zhu,
  • Chao Lu,
  • Tingjuan Zhang,
  • Jun Chen,
  • Yan Wang,
  • Chaoyang Wu

摘要

Objective

This study retrospectively analyzed prognostic factors and quality of life in patients with Non-Small Cell Lung Cancer–Leptomeningeal Metastasis (NSCLC-LM), stratified by the presence or absence of concomitant Parenchymal Metastasis (PM), to inform clinical stratification and individualized therapy.

Methods

We retrospectively reviewed 43 NSCLC-LM patients diagnosed at the Affiliated People’s Hospital of Jiangsu University from September 2016 to April 2025, and classified them into LM-PM and LM-noPM groups according to brain parenchymal metastasis status. The primary endpoint was median overall survival (mOS). Prognostic factors were assessed, and quality of life was evaluated before and after treatment. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors. Quality of life scores were compared using paired sample t-tests. Scale reliability was assessed via Pearson correlation coefficients and Cronbach’s alpha. Statistical significance was defined as a two-sided P-value < 0.05.

Results

The mOS was 5.0 months in both groups. Notably, the LM-noPM group demonstrated higher 1-year and 2-year survival rates, indicating a possible long-term survival advantage, although this trend did not reach statistical significance. Multivariate analysis identified non-receipt of anti-angiogenic therapy, adrenal metastasis, and elevated Platelet–Lymphocyte Ratio (PLR) as independent risk factors for poor prognosis. Among patients with good performance status, meningeal irritation signs also constituted an independent risk factor. Quality of life assessment revealed that comprehensive treatment significantly improved global health status and functional domains while reducing symptom burden.

Conclusion

Although NSCLC-LM patients without PM showed a non-significant trend toward improved long-term survival (reflected by numerically higher 1- and 2-year survival rates), the key independent risk factors associated with poor prognosis were the absence of anti-angiogenic therapy after LM diagnosis, the presence of adrenal metastasis, and an elevated PLR. These findings remained consistent among patients with good performance status, among whom meningeal irritation signs also independently predicted worse outcomes. Moreover, comprehensive treatment significantly alleviated symptom burden and enhanced quality of life across multiple domains, supporting longer survival with improved quality.