Abstract: Leptomeningeal metastasis (LM) is one of the most serious complications of non-small cell lung cancer (NSCLC), which is characterized by rapid progression and poor prognosis. The gold standard for the diagnosis of LM is cerebrospinal fluid cytology. Treatments include intrathecal injection, targeted therapy, radiotherapy, systemic chemotherapy and general supportive therapy, and others. Up to now, no consensus has been reached on the prognostic factors, which include age, genetic mutation, clinical symptoms, cerebrospinal fluid parameters, imaging and treatment, and others. In recent years, with the increase in patients with LM, progress has been made regarding liquid biopsy of cerebrospinal fluid (CSF) and new targeted drugs, which have significantly extended the survival rate of patients. The way to achieve precision medicine, according to relevant positive prognostic factors, requires further study. This paper reviews the precision diagnosis and treatment of NSCLC with LM and related prognostic factors.