更新的肺癌分子标志物分级预后评估（lung-molGPA）指数为诊断为晚期非小细胞肺癌（NSCLC）并有脑转移（BM）的患者提供更准确的生存预测。鉴于对于有BM的NSCLC患者，颅脑放疗（CRT）的价值仍有争议，本回顾性研究旨在评估CRT和最佳时机在初次BM的NSCLC患者中的价值，并根据lung-molGPA指数进行分层。本研究筛选了我中心2012年2月至2018年7月期间初次BM的NSCLC患者。使用Kaplan-Meier生存分析评估了CRT和最佳时机的预后价值，并将患者分为lung-molGPA0-2组和lung-molGPA2.5-4组。前期CRT的定义为在初次诊断后3个月内接受CRT且无BM进展，其他CRT被归类为延迟CRT。研究共纳入了288名患者，其中156名患者接受了CRT。中位随访时间为47个月。在整个队列中，中位无进展生存期（PFS）和总生存期（OS）分别为9.2和17.0个月。在lung-molGPA2.5-4组中，CRT可以为初次BM的NSCLC患者带来明显的整体生存益处（HR：0.48，95% CI：0.34-0.68，P < 0.0001），而前期CRT相较于延迟CRT可以进一步扩大这种生存益处（HR：0.49，95% CI：0.27-0.89，P = 0.0026）。但在lung-molGPA0-2组患者中未观察到这种现象。前期CRT可以为这些具有lung-molGPA2.5-4指数的患者带来明显的总生存期益处，但对于具有lung-molGPA0-2指数的患者则不然。©2023。作者（及）独家授权给斯普林格科学+商业媒体有限公司，斯普林格自然出版集团的一部分。

The updated Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (lung-molGPA) index provide more accurate survival prediction for patients diagnose with advanced non-small cell lung cancer (NSCLC) with brain metastases (BM). Given that the value of cranial radiotherapy (CRT) is still controversial for NSCLC patients with BM, this retrospective study aimed to evaluate the value of CRT and optimal timing in NSCLC patients with initial BM after stratified with lung-molGPA index.This study screened NSCLC patients with initial BM in our cancer center from February 2012 to July 2018. The prognosis value of CRT and optimal timing was evaluated with Kaplan-Meier survival analysis and the patients were classified into lung-molGPA0-2 and lung-molGPA2.5-4 group. Upfront CRT was defined as received CRT within 3 months after initial diagnosis and without BM progression, other CRT was classified into deferred CRT.Overall, 288 patients were enrolled in our study, 156 patients received CRT. The median follow-up time was 47 months. In the entire cohort, the median PFS and OS were 9.2 and 17.0 months, respectively. In the lung-molGPA2.5-4 group, CRT can bring significantly overall survival benefit for NSCLC patients with initial BM (HR: 0.48, 95% CI: 0.34-0.68, P < 0.0001), and the upfront CRT can further expand this survival benefits compared with deferred CRT (HR: 0.49, 95% CI: 0.27-0.89, P = 0.0026). But this phenomenon was not observed in lung-molGPA0-2 group patients.Upfront CRT could bring significantly overall survival benefit for these patients with lung-molGPA2.5-4 but not for patients with lung-molGPA0-2.© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.