Won Young-Woong, Joo Jungnam, Yun Tak, Lee Geon-Kook, Han Ji-Youn, Kim Heung Tae, Lee Jin Soo, Kim Moon Soo, Lee Jong Mog, Lee Hyun-Sung, Zo Jae Ill, Kim Sohee
Center for Clinical Trials, National Cancer Center Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-go, Republic of Korea; Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea.
Biometric Research Branch, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-go, Republic of Korea.
Lung Cancer. 2015 May;88(2):201-7. doi: 10.1016/j.lungcan.2015.02.006. Epub 2015 Feb 16.
Development of brain metastasis results in a significant reduction in overall survival. However, there is no an effective tool to predict brain metastasis in non-small cell lung cancer (NSCLC) patients. We conducted this study to develop a feasible nomogram that can predict metastasis to the brain as the first relapse site in patients with curatively resected NSCLC.
A retrospective review of NSCLC patients who had received curative surgery at National Cancer Center (Goyang, South Korea) between 2001 and 2008 was performed. We chose metastasis to the brain as the first relapse site after curative surgery as the primary endpoint of the study. A nomogram was modeled using logistic regression.
Among 1218 patients, brain metastasis as the first relapse developed in 87 patients (7.14%) during the median follow-up of 43.6 months. Occurrence rates of brain metastasis were higher in patients with adenocarcinoma or those with a high pT and pN stage. Younger age appeared to be associated with brain metastasis, but this result was not statistically significant. The final prediction model included histology, smoking status, pT stage, and the interaction between adenocarcinoma and pN stage. The model showed fairly good discriminatory ability with a C-statistic of 69.3% and 69.8% for predicting brain metastasis within 2 years and 5 years, respectively. Internal validation using 2000 bootstrap samples resulted in C-statistics of 67.0% and 67.4% which still indicated good discriminatory performances.
The nomogram presented here provides the individual risk estimate of developing metastasis to the brain as the first relapse site in patients with NSCLC who have undergone curative surgery. Surveillance programs or preventive treatment strategies for brain metastasis could be established based on this nomogram.
脑转移的发生会导致总生存期显著缩短。然而，目前尚无有效的工具来预测非小细胞肺癌（NSCLC）患者发生脑转移的情况。我们开展本研究旨在开发一种可行的列线图，以预测根治性切除的NSCLC患者发生脑转移作为首次复发部位的情况。
对2001年至2008年期间在韩国高阳国立癌症中心接受根治性手术的NSCLC患者进行回顾性研究。我们将根治性手术后发生脑转移作为首次复发部位作为研究的主要终点。使用逻辑回归建立列线图模型。
在1218例患者中，87例（7.14%）在中位随访43.6个月期间发生脑转移作为首次复发。腺癌患者或pT和pN分期较高的患者发生脑转移的发生率更高。年龄较轻似乎与脑转移有关，但这一结果无统计学意义。最终的预测模型包括组织学类型、吸烟状态、pT分期以及腺癌与pN分期之间的相互作用。该模型在预测2年内和5年内发生脑转移方面具有相当好的区分能力，C统计量分别为69.3%和69.8%。使用2000个自抽样样本进行内部验证，C统计量分别为67.0%和67.4%，仍表明具有良好的区分性能。
本文提出的列线图可提供接受根治性手术的NSCLC患者发生脑转移作为首次复发部位的个体风险估计。基于此列线图可建立脑转移的监测方案或预防性治疗策略。
