非小细胞肺癌术后患者脑转移风险预测列线图的构建

An anomogram to predict brain metastasis of non-small cell lung cancer after surgery

目的脑转移的发生导致非小细胞肺癌(NSCLC)患者的生存时间明显减少,但目前尚无有效的预测工具。文中旨在建立一个有效的、可行的列线图用于预测NSCLC术后患者的脑转移发生风险。方法回顾性分析2010年1月至2014年1月马鞍山市人民医院和江阴市人民医院肿瘤科就诊的接受根治性切除术的NSCLC患者636例。分析术后发生脑转移的高危因素,应用逻辑回归方法 R语言软件建立列线图;计算C-index指标的可信区间以及对模型过拟合的程度进行内部验证,评估其稳定性。结果 636例NSCLC患者术后发生脑转移94例。logistic回归分析结果显示,吸烟史(OR=1.783,95%CI:1.037~3.066)、病理类型(OR=0.453,95%CI:0.275~0.744)、T分期(OR=2.047,95%CI:1.511~2.774)、N分期(OR=1.588,95%CI:1.154~2.184)是脑转移发生的危险因素。列线图的一致系数为0.73(0.71~0.82),平均错误率为0.012,提示列线图具备优越的稳定性。结论所得列线图可以用于个体NSCLC患者术后发生脑转移的风险预测,有助于相应的随访和预防策略针对性的开展,最终使此类患者获益。

Objective Brain metastasis of non-small cell lung cancer（NSCLC） significantly reduces the survival time of the patients,and no effective tool is yet available for the prediction of the risk. This study aimed to develop an effective and feasible nomogram for predicting brain metastasis of NSCLC after radical surgery. Methods This retrospective study included 636 cases of NSCLC treated by radical resection of the tumor in our hospitals between January 2010 and January 2014. Based on the analysis of the risk factors for brain metastasis,we developed a nomogram using logistic regression with the R-language,calculated the confidence interval（CI） of the C-index using the bootstrap,and then internally verified the overfitting degree of the model to evaluate its stability.Results Brain metastasis developed in 94 of the 636 patients. According to the results logistic regression analysis,the risk factors for brain metastasis included history of cigarette smoking（OR = 1.783,95% CI： 1.037-3.066）,pathological types（OR = 0. 453,95%CI： 0.275-0.744）,the T stage（OR = 2.047,95% CI： 1.511-2.774）,and the N stage（OR = 1.588,95% CI： 1.154-2.184）. The nomogram showed a coefficient of coincidence of 0.73（0.71-0.82） and a mean absolute error rate of 0.012,which indicated an excellent stability. Conclusion The nomogram we developed can be used to predict the risk of brain metastasis in individual NSCLC patients after surgery,contributing to follow-up programs and preventive strategies for brain metastasis.